Out-of-network mental health hospital covered

Discussion in 'General Parenting' started by Sue C, May 6, 2004.

  1. Sue C

    Sue C Active Member

    as if it were an in-network hospital. Don't know if I'm supposed to offer any input here, but I wanted to say that when Melissa went into the short-term mental health hospital several years ago, it was not in my in-network. I talked to the insurance people on the phone and explained it was the only one around that specialized in juveniles, and I got them to pay the bill as if it were in-network.

    Same thing with the counselor she saw outpatient for a year. She was out of the network but worked mostly with juveniles and there wasn't anyone else close by, so the insurance co. allowed her to be considered in-network.

    It doesn't hurt to ask.

  2. bigblueagain

    bigblueagain New Member

    Sue is exactly correct.......if there is no one usually within a 50 mile radius most carriers will allow a provider to be considered as in network. Again I always encourage folks to read their benefit booklets as there should be language in them to explain this type of exception. If not then call the carrier and ask for Provider Relations and explain the situation. Also if you have changed carriers and your previous provider is not in a new network, sometimes they will allow continuing coverage for "continuity of care" reasons....that is you have already established a relationship with the provider who is not in their network and to avoid interrupting care, they may approve that provider. Sometimes is only for a specific period of time, but never hurts to ask about this either.
  3. missmel3315

    missmel3315 Active Member

    I am in the middle of doing this right now. Cigna calls it ADHOC services. Since ALL of our counselors that are in network work in Corpus Christi 50 miles away they are allowing us to use a local one as our in-network provider.
  4. lb

    lb New Member

    This may be a stupid question, but does an Occupational Therapist (OT) specializing in Sensory Integration Disorder (SID) count as an out of network. Kaiser does not have them, and my son has bigtime food issues. ??
  5. bigblueagain

    bigblueagain New Member

    If you have coverage for Occupational Therapist (OT) for this type of problem then I would believe they should allow you to use oon providers........(OON means OUT of Network). I would caution you to really try to check your benefit language. Many times this is not considered a medical necessity issue. Might have to appeal a benefit if it is not covered.BLUE