Anyone know how to increase insurance reimbursements to dr

Unfortunately there is not much that you can do.  Your doctor can request a review, but he will have to document that the service he provided was more complex that the routine procedure that the benefit allowance was based. The benefit allowances are set by the insurance company themselves.  Your doctor has no obligation to accept what the insurance company considers "usual and customary", therefore you are responsible for the doctor's full fee.  It is very misleading to consumers when the large print on your insurance policy says they will pay 80% of the UCR.  You are then really responsible for everything that is not covered by the insurance which can amount to thousands of dollars in unexpected expenses. That is how an indemnity plan works; there is no panel of participating doctors that have agreed to accept the fee allowances. When a doctor signs a contract with a PPO or HMO the doctor has agreed to accept the insurance fees and the patient is responsible for only his/her co-pay. Hope this is helpful.

Judy, your doctor has some responsibility in this too....how much is he charging compared to the other local providers? As Frayda mentioned, those on a network panel with a carrier have to accept their fees which may be only about 60% of their charged amounts.

Some doctors charge rates that are double or 50% higher than the local "competitors." You may want to call around to other doctors and find out what they charge for procedures. You might also check to see if your plan has an out of pocket maximum, which would offer you some protection once the total has been reached.

As for the appeals, definitely appeal everything, it's your right. But be sure you have more information and documentation each time....eventually your appeals process becomes exhausted and if you get more info later, you won't be able to submit it for condsideration.
Good luck!

---