General question - how do I get this covered in an inssurance claim???!?

[cyberguy137]

Hi,

I'm thinking of seeing a specialist- but they don't handle insurance. A 1 hour consultation is $495.

They said they can give me paperwork to submit a claim. My insurance can cover 50% for "out of network providers". I've never submitted a claim before and I don't know how much will be covered or if they will cover for this condition, because it's so unknown. I'm hoping 50% but there's a chance it will be rejected because they won't know what it is and if it's really necessary.  Can anyone offer any advice?

[Quantum]

Hi cyberguy,
IT all depends if $450 is a very significant amount of money for you that you cannot afford to completely lose on this consultation.  If you go ahead with it, you should be ok with the possibility of losing the whole $450 - insurance company will hardly pay for an almost unheard of, rare syndrome ( in fact, they always seek for reasons not to pay, and rarity of a syndrome unknown to even most doctors will be a fine enough reason for them to refuse to pay).
Also, in order to have reasonable expectations for a first consultation, I suggest you read the second part of this post:  https://poiscenter.com/forums/index.php?topic=2392.msg20182#msg20182

I have also created a list of doctors and specialists who knows about POIS ( at https://poiscenter.com/forums/index.php?topic=2575.msg22338#msg22338 ), and even those do not have much to offer, except they will surely not send you in psychiatry or give you a list of useless tests to do that will all come back normal ( as with all members here who have done all those tests).  You may want to read the information at the top of this thread, too, before investing money in this 1 hour consultation.

It is possible that this specialist have specifically something to offer you because he already have seen other POIS patients and have some ideas, but this would be as rare as POIS itself.  If this is the case, let me know, and I will add this doctor the the POIS doctors list.

[cyberguy137]

Hi, thanks Quantum. You are a true "hero" member in this forum!  I agree with your assessment - this person is unlikely to help , so the $450 could easily be wasted here. I have decided to go back to my PCP (who is covered) to talk to him and get some blood tests (interested in testosterone and prolactin, I guess). I'll then go from there.

[demografx]

Hi, thanks Quantum. You are a true "hero" member in this forum!

I second that!

Demo

[Quantum]

Thanks, Cyberguy ( and Demo) for your good words

It will always be time to invest $450 to help yourself with your POIS, but you are better to wait till something significant worth it. It is a good idea to first work with your PCP.  IF you never showed him the  2 articles which are mentioned in the POIS Doctors post ( at https://poiscenter.com/forums/index.php?topic=2392.msg20182#msg20182), I strongly suggest you either send him the links, or print them and hand them to him ( at least the first one, but best if the second too ).