LSM INSURANCE ASSOCIATES

Everyone talks about wellness & it is important that you get the appropriate annual exams. http://tinyurl.com/25upp36

Based on your age the procedures could require a visit to an outpatient facility. Once your doctor orders a test that must be done at a different location than the office remember to call your carrier before you schedule the actual test. Carriers including the Blue's require you to use specific facilities for certain tests. If the facility is not an approved location the test will be subject to your deductible & coinsurance! Guess who gets to pay that!

To make you’re not paying more than you have to have your doctor’s insurance department provide you with the CPT Code(s) for the procedure then call the carrier’s customer service department. (Be prepared to wait on hold for a while.)  CPT is an  acronym for Current Procedural Terminology. It's a five digit numeric code used to describe medical, surgical, radiology, laboratory, anesthesiology services of physicians, hospitals, and other health care providers and it is used by the insurers to pay bills and reject claims. When you call Customer Service have the CPT code AND the facility location. If you don’t check you could pay thousands for expenses that could be covered for a copay!  

Today, if you fall, have a headache, back pain or a medical problem that is not easily diagnosed, your physician may order an MRI. An MRI (magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. Often, surgery can be deferred or more accurately directed after knowing the results of an MRI. HOWEVER, while it may be critical that you have an MRI, you should know that insurers generally pay them after setting up specific rules that you and your doctor must comply with.

According to costhelper.com as of 4/7/2010, for a patient not covered by health insurance, the typical cost of an MRI ranges from about $1,100 to $2,700, depending on whether the MRI is performed at a doctor's office or hospital and on what part of the body the MRI is done.  BlueCross BlueShield of NC's Health Care Cost Estimator states that an MRI done in a doctor's office ranges from $1,100 to $1,485, while an MRI done in a hospital ranges from $1,458 to $2,090.

Most high-tech scans called nuclear cardiology studies such as CT or CTA scans, MRI's, MRA's, & PET scans or special heart scans do require prior plan approval from your insurance carrier.    Even if the test is approved be aware that it is generally covered AFTER you have satisfied your health insurance’s deductible. To check on which diagnostic imagining procedures require prior approval with your carrier go to your carrier website and search for “diagnostic procedures requiring prior approval” or call LSM Insurance Associates to help you find this information.

"You need an MRI."

Today, it is VERY common for your doctor to suggest this. An MRI scan is a radiology technique which produces images of body structures and is used as an accurate method of disease detection. While it may be important to get the MRI, you should know that generally your insurer will only pay for it once your deductible is met. According to CostHelper.com an MRI done in a doctor's office in North Carolina ranges from $1,100 to $1,485, while an MRI done in a hospital ranges from $1,458 to $2,090. Be aware that your insurer may NOT pay for an MRI in a hospital setting UNLESS you have gotten preapproved. With deductible's running $5,000 a person, you need to ask your doctor some questions before you lie down on the cold slab!

     *Why do I need this MRI? 

     *What will this test show that other tests will not? 

     *Are there other tests you can try first

      *What is the CPT code for this test?

Current Procedural Terminology codes is a five digit numeric code used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians, hospitals, and other health care providers. There are over 7800 different codes & insurers base their payments on how these codes are entered by your doctor/hospital.

 

Once you have it call your insurer BEFORE YOU SCHEDULE THE MRI. (Yes, you will be on hold for a while so bring a book

Write down the name of the customer representative & make sure you get a reference number regarding your conversation. Then you can make an informed decision as to whether to get the MRI.

A number of you have asked me about what I think about a National Health Care plan and I think that Congress is biting off more than it can chew.  Here is a video by ABC's John Stossel which points out a number of issues that aren't being addressed or discussed about the Obama program. Right now we have great medical care in the US as compared to other countries and we get to make our own choices. (yes I know we have problems but we don't have to make swiping changes to fix them)  Ask someone on Medicare how they feel about their healthcare plan and you will get a sense of how challenging a national health care plan might be for us Under 65'ers. Check out this video & make your own decisions. http://www.youtube.com/watch?v=q9GMKK_fWKg

If you feel like Congress is going the wrong way then go to my page ??? National Health Plan to find a link to telling your congressional representative how you feel.

The January 2010 BCBSNC rates have started arriving in mail boxes and so far, I have seen 12% renewals on average but I have also heard about some larger increases. With medical trend around 8% these are a little higher then expected.  I believe that the increase is being set based on what your current deductible is. The lower your current deductible is the higher your renewal increase will be.

When you look at your renewal options, you may want to consider a Health Savings Account. The key to using an HSA is that you need to understand how they work. When you add up your deductible, your maximum out of pocket expenses with the annual premium a HSA generally costs less then a PPO plan. However, the hard part of an HSA is that you have to be willing to give up your copay benefits which for some people will be really difficult. If you go to my Health Savings Account page you can find out the HSA limits for 2010 as well as look at other resources resources.

If you currently have BCBSNC Blue Advantage, be on the lookout for your annual renewal letter. It should arrive in October and you have the month of November to make changes. Per Blue Cross, the lower your deductible, the higher the rate increase will be. You should also be aware that with most individual carriers your rates are also affected by a change in your age band. What that means is that if you hit that 45th birthday, your rates move from the 40-44 age bands to the 45-49 age bands, etc. which makes your renewal is that much higher! Remember, you have options and we can help.