A few years back I changed jobs; under my previous employer my allergy shots were fully covered under insurance, and I wanted to determine which of my new employer's plans might cover them. At the time I was getting allergy shots on a weekly basis, so if I had to pay it could add up to $80-$100 a month. If "plan A" covered it and cost only $30/month more than "plan B," then it would be worth it to me.
The plan summary from HR didn't say. I called the insurance company, but it was tough to get an answer from their CSRs without being a customer. Finally I got someone sympathetic who gave me their direct line and said if I could get the billing codes, they could run it against the terms of the policies my company negotiated and see what comes up. In the meantime they told me it would cost no more than $25 per injection, which was the limit to "usual customary and reasonable" in my area.
So then I call my allergist's office. They told me I need to speak to their business manager, who only worked 3 days/week, and I of course called on one of those other two days. When I called back, she categorically refused to give me the billing code they'd use. I asked her to clarify whether she was unable to give me the code or if she was choosing not to do so, and she responded that it was the latter.
So basically I just had to wing it and choose a plan. And a new allergist.
feel lucky you don't have a kid with medical problems.
I've had to drag out accepting an offer from a company so I could find out 100% if my child's doctor was covered by their insurance or not. In the end I had to turn it down because he wasn't in the network, and having to pay the 20k out of network deducible would have ate any net gain I would have gotten by taking that job, I had to turn it down.
I felt bad dragging out the process so long, but I really had to cover myself, and at least on their side they were 100% understanding.
This sucked, however we're still lucky. We had her (hopefully) last surgery last week. While staying in the Ronald McDonald house (her surgeon just moved further away from us) we got to hear tales of people having their house foreclosed on, due in part to their kid going through leukemia treatments (they were/are insured btw).
You shouldn't have to lose your house because of medical necessity
And I hope in the future you might have an opportunity to to sign on with that employer later -- it sounds like if they're understanding while you tried to sort out the insurance questions, then they'd probably be good people to work for.
I tried reaching out to them a few months after it all went down, and my wife could pick up insurance. The main contract they had was set to be cancelled (they also canceled contract with 15 other companies) so in the long run it worked out for me.
oh, and my Daughter is fast to recovery, just need to keep her from bouncing off the walls for another with week, which is impossible for any 5 year old.
My allergist charged a "rack rate" of $24 per injection, just under the $25 line that the insurance company said was UCR.
It turned out the insurance company's contract with the allergist said he could charge me no more than $18.50, but the insurance company paid none of it. So even then it was $74/month, given that I had to go weekly.
Because of the stupid game that I had to play, I had absolutely no way of knowing what that discount would be though. Could have been nothing, could have been a lot. Hence "could" add up to nearly $100 a month if I had to pay full price.
The plan summary from HR didn't say. I called the insurance company, but it was tough to get an answer from their CSRs without being a customer. Finally I got someone sympathetic who gave me their direct line and said if I could get the billing codes, they could run it against the terms of the policies my company negotiated and see what comes up. In the meantime they told me it would cost no more than $25 per injection, which was the limit to "usual customary and reasonable" in my area.
So then I call my allergist's office. They told me I need to speak to their business manager, who only worked 3 days/week, and I of course called on one of those other two days. When I called back, she categorically refused to give me the billing code they'd use. I asked her to clarify whether she was unable to give me the code or if she was choosing not to do so, and she responded that it was the latter.
So basically I just had to wing it and choose a plan. And a new allergist.