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Insurance covering Orthopedic Specialist?

Wildworld89WWildworld89 Posts: 2
edited 05/19/2015 - 9:58 PM in Chronic Pain
I have been suffering from chronic pain for years and finally have gotten to the point I know I must see an orthopedic specialist. I am aware I have a hyper kyphosis of the spine and want to be screened for the degree of curve and see if it's postural, schuermanns or another issue altogether. I know insurance plans do differ but have any of you guys had luck with insurance paying for any part of the office visit/check up when your deductible hasn't been reached? Is this possibly seen as preventive care? I have blue cross blue shield of TN for what that is worth. I am recently graduated from college and new to the complicated world of health insurance s please excuse my naive nature with this manner.

Any feedback would be appreciated



  • LizLiz Posts: 7,832
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  • dilaurodilauro ConnecticutPosts: 9,865
    that only your insurance carrier can answer. Its understandable that you are not all that familiar with how insurance companies are working. So many things have changed over the past couple of years. But basically, there are so many different insurance carriers and different plans. Each one has their own set of rules and regulations.

    From my own experience, when you have not met your deductible, you will have to pay.

    Also, the bottom line in insurance coverage has to do with the medical billing. How the doctor submits the bill to the insurance carrier using specific medical billing codes will determine how the insurance company will handle it.

    So, lets assume that your insurance carrier provides coverage for "preventive care". That would mean your doctors office would have to submit the bill for you as being under preventive care... Which then would jeopardize the doctor's office for falsifying medical documents. I dont think you will find my professionals who would do that.
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • So if I wanted an estimated price quote for my appointment who would give me that? The orthoepedic doctor's office or my insurance company? I would just feel more comfortable knowing around what my visit might cost me out of pocket.
  • dilaurodilauro ConnecticutPosts: 9,865
    companies have tools that can give you estimated charges for specific visits in given areas.

    So, you could get an estimate of what it would cost for]

    - Clinical examination to determine if there could be a spinal problem
    - Performed xx miles from where you live

    I've done that to get estimated costs for MRIs, CTScans, etc
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • PlumbTuckeredOutPlumbTuckeredOut Philadelphia, PAPosts: 325
    Try calling your insurance company OR Human Resources where you work if they are providing your insurance. Trust me, you will only be about 1 in a million of other people who are totally confused by deductibles, co-pays, specialist vs preventative care. I was also a huge phone-o-phobe, afraid to call people, tell them this first and ask for a kindly old customer representative who can talk slowly to you!
    You have insurance so things will work out. Every time I go the front desk asks me, "Would you like to make a payment today?" and I answer in my politest form, "No, I'd really prefer to have groceries this week but if you really insist...." I've never gotten snarled at!

    Two roads diverged in a wood, and I took the one less traveled by...... (Robert Frost)
    I still don't know if I should have taken the one that said, "Caution! Dead End" (Me)
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