Every insurance plan has its own rules. Some insurance carriers have different levels of coverage within the overall company, and their rules may vary widely. For example, Blue Cross has HMO Blue, Blue Cross PPO, Blue Cross Out of State, Empire Blue, Medex and Blue Care 65. Each has its own set of rules.
In order to be sure what your coverage is and responsibility is, you must call your insurance company (the phone number will be listed on your insurance card) and ask your benefits team about your coverage and responsibility. Knowing what to ask is key.
You will want to know the following:
- Do I have a co-pay? If I do, how much is it for this service?
- Do I have a deductible? If yes, what is the amount? Have I met it?
- Is there a co-insurance?
- How many visits am I allowed within a specified time?
- When does my benefit year begin and end?
- Do my visits require an authorization and if so, how do I obtain one?
- Does the authorization have to be in place before I begin my service?
- If I began treatment without an authorization in place will the insurance allow backdating to cover it?
- Who is my primary care provider (PCP)?
- If I have been treated for this condition before, will insurance cover new visits?
- Is MetroWest Medical Center (MWMC) in network or out of network? What tier?
- Is therapy considered a “specialist”? (If so, the co-pay may be higher than an office visit)
Should your insurance carrier ask, the MetroWest Medical Center Rehab Services NPI# is 1740252592.