Health insurance .......?

Question

i am about to take up health insurance but i am not sure how it works

I recently contacted the BLF and they said that i have classic symtoms of Bronchiectasis, results from a chest x-ray revealed nothing and my doctor will not refer me to a chest physician because of this.

If i do a CT Scan for my lungs privately will my new Health Insurance cover the cost ?

Answer 1

CT scans usually need authorization from your health insurance. So, if you decide to do it on your own, you're probably on your own trying to pay for it.

Have you actually been diagnosed as having Bronchiectasis?
The way you usually diagnose Bronchiectasis is through xrays, and CT scans... So, I'm assuming they were unable to confirm a dx via chest xray... And, you want a CT?... There are other tests that probably need to be done if the xray was negative...

And, you may not need to see a Pulmanologist without CT results to confirm your diagnosis. Will your doctor request the CT scan? A Pulmonologist may not even agree to see you without the results of a scan, so I'd stick with your doc. Tell them you want a CT. See what they say... If they disagree, ask them for a diagnosis... Like what do they think is wrong with you if not Bronchiectasis???

If it fails, call the insurance. Ask them what type of proof do you need to provide of medical necessity to have the scan covered. See if you can request authorization for the ct, without a doctor's permission. Its possible you may have symptoms will immediately qualify you for the test. good luck

Answer 2

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Answer 3

If you have a HMO plan, you must get a referral from your PCP first, or it won't be covered.

If you have a HMO with POS option (this allows you to go out of network, usually without a referral), a EPO plan or a PPO plan, you can go wherever you want without a referral.

The problem is, once you're there, the radiology facility needs a prescription in order to do the test. A person can't just walk in off the street and ask for a lung CT scan; there has to be something from a physician stating the exact test that's to be done.

If you believe you need a referral to a specialist, you have the right to demand it. Tell your doctor that, unless he or she gives it to you, you'll switch doctors. Just be prepared to do this if you don't get the referral.

Answer 4

I work for Blue Cross Blue Shield of NJ... usually, I'm finding the majority of health policies base things on medical necessity. If you have a PPO policy, you should be able to go to a specialist to get a prescription for a CT Scan. If you have an HMO policy, you do need the referral from your Primary Care Physician. If they won't give it to you, try going to a new doctor. Most policies do not have a restriction on when and how many times you change your PCP.

Answer 5

If it is a HMO then there is no pre existing condition limitation that they will hold you to. Any other insurance PPO\OAP and any other insurance will no allow it for 6-12 months after covered.

Answer 6

Depends on your health insurance plan, you might have to contact them and ask.

Answer 7

Why not call the BUPA/PPP (or whatever Insurance you have) Helpline and ask them ???