Hello,
I just met my deductible for this year and I need to see a pelvic floor therapist. My insurance blue shield of CA does not cover pelvic floor so these places will have to send me a super bill. If I send a super bill to blue shield will they cover 100% because I met my deductible for this year? or how can I get them to pay 100% of super bill? they usually reimburse so little.
No, once you meet your OOPMAX (not your deductible), insurance will cover 100% of in-network covered services.
However, if you’re getting care for an excluded service or from an out-of-network provider, your insurance will NOT cover these at 100%.
This is the answer: Once you meet your in-network OOPM, only medically necessary, non-excluded, in-network care will be covered at 100%. If the care doesn’t meet all three of these, it won’t be free for you.
Is the therapist out-of-network, or is it a non-covered procedure, or both?
If out-of-network: No, they won’t cover the full amount for a provider without a contract.
If non-covered (or both): The non-covered services will be excluded from any claim you submit and won’t be reimbursed.
Unfortunately, you’ll need to use your OOP on covered services. If you qualify for a breast reduction, eye lift, or varicose vein surgery, now’s the time to act!
Or, you can see a specialist who understands your situation and explore other options besides Kegels.
Not for a non - covered service.
Unfortunately, a non-covered service means exactly that—NON-COVERED. Even if your doctor thinks it’s necessary or you’ve met your out-of-pocket max and deductible, the service won’t be covered under your plan.
Does your insurance not cover PT at all? How do they exclude pelvic floor?