What if my PPO provider claims the cost of my care is 'excessive'?
Based on the locality that you live in. If you're in Beverly Hills or if you're in a small town in Alabama. There will be a different cost associated with the care of your genealogist or your family care doctor. Each insurance company has these reasonable value care assessments they make based on your zip code. And so, you can go to someone in Beverly Hills and the insurance company will say, well we think that they're way to expensive, just because of their location and because of their overhead. And so in fighting that you have to; that's one of those things that before you go there you have to try to find out what they're going to pay for care given. If you go to a world renowned specialist verses a garden variety person, they're usually going to pay on both the same amount of money. By the pre authorization process you can find out ahead of time, what they're going to pay. If you haven't done that and you find out that they have suggested the fifty percent of someone's bill is unreasonable, you again enlist your doctor to help you, because the doctors don't like to be seen as unreasonably extravagant in their cost. And they will usually help you with a letter to the insurance company explaining why your procedure needed all these different costs and that it wasn't that their fee was high.
