Americhoice and out-of-network reimbursement

I live in NY and have coverage by Americhoice. I have a condition that is baffling my docs and they cannot help me. I need to see a doc who is out-of-network, I need to pay cash. Does anyone know if there is a possiblity of receiving reimbursement from Americhoice?
Also, due to the nature of the condition I am in need of counseling to help me cope with it. I am paying out of pocket and wondering if there's any way Americhoice would reimburse my fees. (Please don't suggest the clinics; I'm a lot older than most of the clinicians there)

Posted: Tue, Apr 17 2007, 9:37 pm Post subject:

I doubt they'll reinburse for those, but you can ask....
Isn't it okay to see clinicians that are younger than you? Hey, if they know they're job.....
anyway, Hatzlocha and hope everything works out (and that you don't have to pay too much!)
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Silver Member Joined: Dec 01 2006 Posts: 688

It all depends on the specifics of your policy (I would think). A lot of insurance companies pay for out of network services at a certain rate (ie 80%) after you meet a certain deductable.

Bracha, I highly doubt a 25-year old has the experience of a 55-year old. It's the way things work, naturally...

Platinum Member Joined: Aug 01 2005 Posts: 16955

If youre in the need of services that americhoice doesnt provide, maybe it's a good idea to get an individual policy at a regular insurance company, or switch your medicaid hmo to one that does cover what you need?
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Mama dear, these practitioners do not accept any insurances.

Platinum Member Joined: Aug 01 2005 Posts: 16955

then americhoice probably wont reimburse you. but some other insurances like oxford will reimburse you after a deductible. you should look into your options. are you talking about counseling/therapy?

I am currently also paying out of pocket for a doctor. As a general rule Americhoice does not cover Manhattan and that's where the better doctors are. I am now paying thousands of dollars bec. I need a specialist not covered by medicaid on any plan. I can not get insurance to cover as the plan I need would cost me even more than what I'm paying now. I am broke and have to borrow to pay this bill but there is no choice.
Medicaid has covered some big bills for me so overall it really has been good to me.