Cancer Treatment Centers of America in Networks?

[yorkriver1]

A prospect has a grandfathered plan--yes, Virginia there are actually grandfathered plans--. It's with BCBS & the plan turned down CTCA, or me being new to the situation, maybe they were done as OON/UCR and higher OOP's. The CTCA locations are out of state. That is tough in today's local network environment. Point is, client won't get the coverage they want, as they understand it.

Anyone have experience with CTCA?

 

[yogooglethis]

A prospect has a grandfathered plan--yes, Virginia there are actually grandfathered plans--. It's with BCBS & the plan turned down CTCA, or me being new to the situation, maybe they were done as OON/UCR and higher OOP's. The CTCA locations are out of state. That is tough in today's local network environment. Point is, client won't get the coverage they want, as they understand it.

Anyone have experience with CTCA?

I believe pre ACA and ACA plans excludes most voodoo medicine type of alternative treatments for cancer and other diseases.

 

[goillini52]

A prospect has a grandfathered plan--yes, Virginia there are actually grandfathered plans--. It's with BCBS & the plan turned down CTCA, or me being new to the situation, maybe they were done as OON/UCR and higher OOP's. The CTCA locations are out of state. That is tough in today's local network environment. Point is, client won't get the coverage they want, as they understand it.

Anyone have experience with CTCA?

They run lots of infomercials on T.V.

 

[kgmom219]

You need to start with "its not a fact until YOU know its a fact"

The client says "its not covered". That's way too generic. Is it covered but hitting the deductible/coins? In or OON? Procedure is a contract denial? The girl making minimum wage coded the liver cancer chemo with a kidney cancer diagnosis and it rejected?

OK, I'm exaggerating. A little bit. Very little.

Get the dates of service the client is upset about. Assuming you are the agent on the policy, call the carrier and find out what the problem is. THEN you can figure out a plan of action. If you aren't the agent, then you will have to call with them on the phone. Or ask for the EOB's. But you will probably have to call either way.



If you are trying to find a new policy for 2/1 that specifically covers CTCA, I would call them. (Or have the client do it.) And find out who they are in network for. Then sell them a new policy with the carrier they requested.

 

[yorkriver1]

Thanks for feedback, and KG, your detailed suggestions are a big help, for any claim issue, not just this situation. I am not the current agent, and don't think I can improve the coverage to pay what this person would like to have covered. So far no carriers have CTCA in network.
I may refer this person to Patient Advocate Foundation, where there are counselors who help people with serious illnesses navigate the various issues they encounter with treatment.
New insurance doesn't seem to be the answer, so far.