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Insurance For Imo

tmoe

Asked by tmoe,

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tmoe Collaborator

tmoe

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Posted

Happy Holidays To Everyone, Is there anyone who has use there insurance to get a medical opion (secondary insurance SSDI, Blue-

Cross,Care Improvement) just to name a few. I have heard some insurance would pay for a medical opion for you.. I need one and this

would be a big help for us or for vets if this is true. I will try my insurance after the first of the year but just asking if anyone has ever tried

this through private insurance..TM

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john999 Grand Master

john999

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I used Blue Cross for an IMO twice. All it is is a second opinion. The doctors know how to use medicare and your insurance to get paid. Now BC or medicare is not going to pay $5000 for some high class records review and major medical brief. They will pay a certain amount. I got mine for about $300. There are some doctors who advertise here who want big bucks and it may be worth it, but I don't think insurance will pay all that freight. The thing is you don't always need to have each page of your medical records reviewed in detail. You may need for the reasons and basis of your denial to be rebutted and for the doctor to say he/she reviewed all your records. If you are trying to prove something on the fringes that needs many medical footnotes and citations then you may have to pay.

John

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tmoe

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Insurance will not pay for an IMO.

It has to be an IME or examination so you will have to go be examined.

What state are you in?

J

I'm in SC, but I have heard Care-Improvement will pay for an IMO but you have to find a doctor that will do it through the insurance. I had a doctor in Charleston SC

that would file insurance but my computer crash and lost all contacts and everything else. They even pay you for travel pay as well or i was told

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broncovet Grand Master

broncovet

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An IME is always better than an IMO any way, IMHO. Why? An IME is an Independent Medical EXAM. (The doc could also view your records and comment on them, too) An IMO is just the doctors review of what other doc's wrote in the medical records.

I think an important difference between IME and IMO is that an IME could be used as New and Material Evidence, while an IMO would not. Reason: The doc, in his exam, could offer "new" medical opinions, but an IMO he would be simply opining on what other docs said in the past, so it would not be "new" evidence...just redundant of the "old" evidence.

It appears that an IME = IMO + new exam. However, the doc would "not necessarily" review all the old records to do a new exam.

Bottom line: Get an IME if the insurance co wont pay for an IMO, its better anyway.

If the doc you are seeking is "local" there may not be any compelling reasons "not" to have an exam with the docs opinion anyway.

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tmoe

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I used Blue Cross for an IMO twice. All it is is a second opinion. The doctors know how to use medicare and your insurance to get paid. Now BC or medicare is not going to pay $5000 for some high class records review and major medical brief. They will pay a certain amount. I got mine for about $300. There are some doctors who advertise here who want big bucks and it may be worth it, but I don't think insurance will pay all that freight. The thing is you don't always need to have each page of your medical records reviewed in detail. You may need for the reasons and basis of your denial to be rebutted and for the doctor to say he/she reviewed all your records. If you are trying to prove something on the fringes that needs many medical footnotes and citations then you may have to pay.

John

John, I will have an up hill battle but it can be done (HTN & PAD) secondary to chronic pain,depression,lack of exercise from pain,and from my sc orthopedic disabilities. I just can't believe some of these guys want 6-7-8 thousand dollars for an opion thats not guarantee to get anything for you

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tmoe

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An IME is always better than an IMO any way, IMHO. Why? An IME is an Independent Medical EXAM. (The doc could also view your records and comment on them, too) An IMO is just the doctors review of what other doc's wrote in the medical records.

I think an important difference between IME and IMO is that an IME could be used as New and Material Evidence, while an IMO would not. Reason: The doc, in his exam, could offer "new" medical opinions, but an IMO he would be simply opining on what other docs said in the past, so it would not be "new" evidence...just redundant of the "old" evidence.

It appears that an IME = IMO + new exam. However, the doc would "not necessarily" review all the old records to do a new exam.

Bottom line: Get an IME if the insurance co wont pay for an IMO, its better anyway.

If the doc you are seeking is "local" there may not be any compelling reasons "not" to have an exam with the docs opinion anyway.

I already know the problem just need to get an opion to connect the dots together

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