How to find out allowed amount for compression garmets?

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angboy
angboy Member Posts: 1
edited June 2014 in Employment, Insurance, and Other Financial Issues

I recently bought a compression bra for lymphedema and the cost was $120. The place I bought it told me they thought my insurance- federal BC/BS reimbursed $50 so I'd pay the difference. I paid $70 and they filed the claim. Meanwhil I called BC/BS and was told by someone that since I got it from a preferred provider, they'd pay 100% of the billed amount, so I thought I'd get the full $120 paid. I called BC/BS today to ask about it and was told they paid $39.50, the allowed amount. I couldn't find ANYWHERE any documentation of what the "allowed amount" is. Does anyone know how I can acess this info somewhere?

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  • lauri
    lauri Member Posts: 267
    edited October 2010

    Eventually you'll get an EOB (Explanation of Benefits) that will spell it all out -- sounds like there's a maximum amount BC/BS shows as "reasonable and customary" and then they pay a percentage of that.  When I was going through treatment I went on the BC online system and left them email notes asking questions (beats sitting on the phone!) and they generally respond quickly.

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  • lauri
    lauri Member Posts: 267
    edited October 2010

    Eventually you'll get an EOB (Explanation of Benefits) that will spell it all out -- sounds like there's a maximum amount BC/BS shows as "reasonable and customary" and then they pay a percentage of that.  When I was going through treatment I went on the BC online system and left them email notes asking questions (beats sitting on the phone!) and they generally respond quickly.

    · Share on FacebookShare on Twitter

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