Kaiser- How Easy is It to Get Out of Network Coverage?

[somarco]

My pelvic pain pt accepted the blue cross rate of ~ 90$ as apposed to what she bills (225) is this what you mean by fee schedule?

Similar, but not the same.

In GA KP is only HMO for individual coverage. In other states it might be different.

HMO reimbursement is generally lower than PPO rates but offset (at least with the PCP) with a monthly per capita payment.

Not only must the doc agree to KP's reimbursement but other terms of service as well. With KP's integrated record keeping, a non-par provider or even a par ancillary provider is at a disadvantage.

And . . . even if the provider agree's to all the stipulations KP must approve them.

if i am going under my mother's insurer (she will be getting it from work) and havent had a lapse in coverage would they deny coverage for my issue?

Assuming it is a true group plan you cannot be denied based on what you have posted.

 

[marketpantry]

I was referring to out of network coverage. are you saying you dont think they can deny it if its a group plan?