What is a Cadillac plan?

[chri'stina 190]

I think it's because of the plan we have now, which is costing us a lot less per month than the last one, but we pay more in situations like MRIs. I don't have all the info in front of me to say how our plan is set up but we had to pay like $700 for the MRI for Kavi (he is fine btw, it was last January for an issue that turned out to be nothing but the DR wanted us to get it done). Our insurance wouldn't approve a cat-scan which is what the Dr wanted done in the first place, only an MRI. Our last plan was much better in terms of what we paid when something like that happened, but the monthly rate was a lot higher--so maybe we are actually doing better with this current plan anyway.

[Trumplestiltskin 5,791]

I think it's because of the plan we have now, which is costing us a lot less per month than the last one, but we pay more in situations like MRIs. I don't have all the info in front of me to say how our plan is set up but we had to pay like $700 for the MRI for Kavi (he is fine btw, it was last January for an issue that turned out to be nothing but the DR wanted us to get it done). Our insurance wouldn't approve a cat-scan which is what the Dr wanted done in the first place, only an MRI. Our last plan was much better in terms of what we paid when something like that happened, but the monthly rate was a lot higher--so maybe we are actually doing better with this current plan anyway.

It boggles belief that the insurance companies override the advice of doctors when deciding what diagnostic procedures are necessary. Who decides that an MRI is better for your situation than the Cat Scan that the doctor recommends?

[chri'stina 190]

I think it's because of the plan we have now, which is costing us a lot less per month than the last one, but we pay more in situations like MRIs. I don't have all the info in front of me to say how our plan is set up but we had to pay like $700 for the MRI for Kavi (he is fine btw, it was last January for an issue that turned out to be nothing but the DR wanted us to get it done). Our insurance wouldn't approve a cat-scan which is what the Dr wanted done in the first place, only an MRI. Our last plan was much better in terms of what we paid when something like that happened, but the monthly rate was a lot higher--so maybe we are actually doing better with this current plan anyway.

It boggles belief that the insurance companies override the advice of doctors when deciding what diagnostic procedures are necessary. Who decides that an MRI is better for your situation than the Cat Scan that the doctor recommends?

I know...the only explanation I could think of is maybe sometimes the Cat scan doesn't give enough info in those cases and an MRI is almost always needed in the long run. But I don't have any proof of that.

[spookyturtle 9,466]

Would you rather have the Kia plan?

I might settle for a Toyota plan.

Now that they are the undisputed #1, how long before they end up like GM?

[w¡n9Nµ7 §£@¥€r 123]

MRI's cost a lot more than CAT's do.

[Pinocchio Liberal 268]

The Obama plan must be like tax for clunkers? I also wonder if the goverment will have a co-pay for the lip balm your gonna need to make it easier to suckle the govament teet?

You're strangely obsessed with suckling - seems to be a common theme in a lot of your posts.

I hope you're not one of those guys who goes in for that adult baby / domination thing.

I think its more like your obsessed with what you think I think im obsessed with.

[w¡n9Nµ7 §£@¥€r 123]

The Obama plan must be like tax for clunkers? I also wonder if the goverment will have a co-pay for the lip balm your gonna need to make it easier to suckle the govament teet?

You're strangely obsessed with suckling - seems to be a common theme in a lot of your posts.

I hope you're not one of those guys who goes in for that adult baby / domination thing.

I think its more like your obsessed with what you think I think im obsessed with.

I know you are but what am I!

[chri'stina 190]

MRI's cost a lot more than CAT's do.

I know.

[Trumplestiltskin 5,791]

I had a similar thing with a lymphoma biopsy a few years ago - where because the disease is notorious difficult to diagnose the doctors recommend a multi-slice pathology of the removed lymph nodes, but frequently insurance will insist on a (less accurate) single slice examination.

I still have no idea what it was I actually got...

FIL was almost killed by his insurer a few years ago - decided that someone with a chronic heart condition did not need to see a cardiologist on a regular basis. One hospitalisation later - he's back on the appointments.

[Pinocchio Liberal 268]

The Obama plan must be like tax for clunkers? I also wonder if the goverment will have a co-pay for the lip balm your gonna need to make it easier to suckle the govament teet?

You're strangely obsessed with suckling - seems to be a common theme in a lot of your posts.

I hope you're not one of those guys who goes in for that adult baby / domination thing.

I think its more like your obsessed with what you think I think im obsessed with.

I know you are but what am I!

The flap jack eating champ!

[Trumplestiltskin 5,791]

The Obama plan must be like tax for clunkers? I also wonder if the goverment will have a co-pay for the lip balm your gonna need to make it easier to suckle the govament teet?

You're strangely obsessed with suckling - seems to be a common theme in a lot of your posts.

I hope you're not one of those guys who goes in for that adult baby / domination thing.

I think its more like your obsessed with what you think I think im obsessed with.

I know you are but what am I!

He's just angry cause I caught him out.

I bet he's in his Depends right now, shaking the bars of his crib while a Dominatrix in high heels paces about in front of him with a bullwhip and a jar of baby food.

[spookyturtle 9,466]

The Obama plan must be like tax for clunkers? I also wonder if the goverment will have a co-pay for the lip balm your gonna need to make it easier to suckle the govament teet?

You're strangely obsessed with suckling - seems to be a common theme in a lot of your posts.

I hope you're not one of those guys who goes in for that adult baby / domination thing.

I think its more like your obsessed with what you think I think im obsessed with.

I know you are but what am I!

He's just angry cause I caught him out.

I bet he's in his Depends right now, shaking the bars of his crib while a Dominatrix in high heels paces about in front of him with a bullwhip and a jar of baby food.

His mom must have gone shopping and he's using the computer without permission. What a little wanker.

[rebeccajo 14]

Is it just possible that regular doctors/specialist visits and the odd MRI don't count towards my deductible, that's why I don't know?

I think visits to doctors and hospitals that are affiliated with the PPO don't count towards the deductible.

I see. I know I verified that MRIs don't need pre-certification as long as they're within network. Hopefully you're right and this is fully covered.

Wot?

Are you saying that something has to be out of network to apply towards the deductible?

Edited July 29, 2009 by rebeccajo

[w¡n9Nµ7 §£@¥€r 123]

Is it just possible that regular doctors/specialist visits and the odd MRI don't count towards my deductible, that's why I don't know?

I think visits to doctors and hospitals that are affiliated with the PPO don't count towards the deductible.

I see. I know I verified that MRIs don't need pre-certification as long as they're within network. Hopefully you're right and this is fully covered.

Wot?

Are you saying that something has to be out of network to apply towards the deductible?

I don't know. I will find out soon enough.

[Kathryn41 3,205]

I've had 2 MRIs. We have a PPO. In both cases, we phoned before hand to find out what my 'fee' would be. I was quoted $150 in the first instance, which I paid when I had the MRI. Then, because we hadn't met both deductibles for the year, I received a bill for a further $700. The second time, I was very reluctant even to get the MRI because of getting burned by the billing the first time. Again, they called my insurer, asked about deductibles and all and we got a statement from then that the fee would be $85. So, I went ahead and had it done. The insurer completely denied the whole claim and the doctor's office sent me a bill for the whole amount (about $2,000). I called the insurance company and they said that the wouldn't cover MRIs done unless they were at hospitals or in the doctor's office. This was a doctor's office, I told them. They said 'not according to the claim that was filed - it was in a separate clinic'. So, I went to the doctor's office and had them correct their coding error on the submission and re-submitted it. It was denied again! This time when I called they said that they had already made a decision on the file and it was a double submission. I explained about the coding error, so they said to submit again and they would make a note in the file that this was a different code. So, I went back to the doctor's office, had them send out the information again and this time it was accepted. Then, I got a bill for an additional $400 that wasn't included because the deductible hadn't been met, even though we had called to confirm before hand that it was.

The most ironic part of this? The technician didn't do the MRI for the right part of my body that was to be scanned! The results were useless.

Edited July 29, 2009 by Kathryn41