medical expenses and NCP responsibility

[luckymom]

My daughter is on my daughter's stepmom's insurance plan (PP0). Since the plan is based in another state (TX) and we live in IL, I have had many problems with finding in network providers. Daughter is currently in need of therapy, however, there are no child psychologists, or MSW, on the plan in my city at all. Our court order states that I should use in network providers when possible and if I go out of network without good reason, ex doesn't have to pay. Does the fact that there are no providers constitute a good reason? Non PPO coverage is 75% after the deductable, which works out to about $15 each per session. This is certainly well worth it in my opinion, but ex is refusing to pay anything.

 

[nextwife]

Have you contacted the provider directly to ask who you should see for a needed mental health care provider? I have done that on occassion, and my insurance has approved use of individuals when no options within the plan existed.

 

[Phnx02]

Have you contacted the provider directly to ask who you should see for a needed mental health care provider? I have done that on occassion, and my insurance has approved use of individuals when no options within the plan existed.

Yes, you need to call the provider and explain the situation to them. I have the same problem......my child is on my ex's plan that is pretty much exclusive to his state. Since I cannot find in-network docs in my state, and I can't very well travel 1,000 miles to His state to use in-network docs, the insurance company approved me to use any doc....and they will pay the same as if in-network.