Getting the cost of Mini One AMT coverered

[emacsurak]

We have twin girls with CF. They are 11 months old and after battling with ng feeds for the last 10 months- they had Mini One tubes placed last week. Going into the surgery- the doctors told us that we would have 3 mini ones covered each year through insurance. But now as we are trying to get our replacements ordered- insurance is telling us that they only cover $36 of the $190 cost because that is what the government says a g tube should cost. Does this sound accurate based on anyone's experiences? We do not qualify for gov't assistance through SSI, BCMH, or Medicaid. Any thoughts or ideas or similar experiences would be helpful.

 

[Aboveallislove]

Nearly all insurance policies have a price they pay for medical equipment/medicines/treatments that is much less than is charged by the providers. If you use a "preferred" provider then the supplier/provider agrees not to "balance bill" you for the remainder. If you use someone that is not "preferred," than you are liable for the difference. Can you check your insurance and determine whether your policy includes something like that and whether the providers are "in network" or "out of network"? If there are no "in network" providers who can do what you need, then usually insurance covers out of network like it is in network. Call your insurance company and ask for a summary plan description and that should explain these details in simpler terms. And also list the plan fiduciary, whom if you call and explain the situation has a legal obligation to explain to you how to handle, etc.