Medicare, Medicaid, Life and Health Insurance/Questions Answered by Expert Crystal C. Carvotta-Brown

Subject	Date Asked
Pilgrim Harvard PPO	5/24/2010
Q: thanks A: I do not know. You would have to call the 800# on your card and talk to someone in the benefits ...
Insurance refuses to pay	5/13/2008
Q: I had an accident while vacationing and had to get stitches. We ended up in ER but due to a long ... A: See if the health insurer has an ombudsman you can talk to. They should be able to straighten this ...
Humana HMO pre-authorization	5/5/2008
Q: I am having a horrible time trying to get anything pre-authorized. It doesn't appear that anyone at ... A: WOW. That sounds frustrating. Unfortunately there is no standardized way in which this works. ...
Breast Reduction	4/23/2008
Q: i have cigna health insurance through my employer and i got denied due to the amount of grams they ... A: I'm guessing that your plan provisions only consider it medically necessary if they take 496 grams ...
insuance denying coverage on something they once covered	4/18/2008
Q: I had Great West Insurance last year. They were supposed to clean up the mess that the previous ... A: Yes - as far as I am aware, they are two very different items. So the insurance company you are ...
insuance denying coverage on something they once covered	4/18/2008
Q: I had Great West Insurance last year. They were supposed to clean up the mess that the previous ... A: It sounds like orthotics are an EXCLUSION on your plan. Unfortunately, plans can exclude anything ...
insuance denying coverage on something they once covered	4/18/2008
Q: I had Great West Insurance last year. They were supposed to clean up the mess that the previous ... A: If you have not done so already you should ask your surgeon to write a letter of medical necessity ...
Pre-medical condition	4/15/2008
Q: We are moving from MA to CT or NY, depending where we will get an health insurance. I had cancer ... A: You should be able to purchase health insurance from any number of plans in MA or CT, including Blue ...
Breast reduction coverage	3/25/2008
Q: I currently have an HMO with Cigna through my employer. I received letters from two doctors stating ... A: If your carrier (in this case Cigna) doesn't cover the procedure and it is listed as an exclusion in ...
Out of Network Coverage	3/25/2008
Q: My mother wants to have an operation done by a surgeon who accepts her insurance (UPMC); however, ... A: She may simply try contacting the insurance company and explaining the situation. Its possible that ...
insurance covered cell phone	3/21/2008
Q: i have a son with TBI. i was told that medicaid would cover payment for a cell phone for him. i was ... A: My recommendation would be for you to contact Medicaid yourself and ask them if there is a specific ...
clinical trials	3/14/2008
Q: Is the provider required to inform the patient's insurance company that the patient is enrolled in a ... A: That's a very good (and interesting) question that I'm afraid isn't in my area of expertise. My ...
Gastric Bypass Surgery	3/6/2008
Q: I am on SSI with medicaid insurance. I feel that if I was to get the surgery and loose the weight, ... A: Rosalee... Generally speaking, if a health insurer (or Medicaid) has a procedure listed as an ...
private insurance	2/28/2008
Q: A family member is ESRD. She has medicare and NC teachers insurance. It medically necessary that she ... A: There are a couple of things you can try. First ask the folks at Davita if they have a case ...
who's at fault with aetna	2/7/2008
Q: i have Aetna managed choice ppo. my PCP wanted me to have a CT based on abdominal pain. his office ... A: Since your PCPs office made the appointment for you at the local hospital, ask the referral people ...
health provider bills	1/30/2008
Q: I received a bill from a provider today that was addressed to my 21 year old daughter and me. When I ... A: I doubt they would waste their time to tell you the truth. It sounds like it is just a "scare ...
lap band appeal	1/29/2008
Q: I was denied the lap band procedure. Obviously Aetna didn't read what was sent in the first place ... A: It appears as though Aetna holds itself out to be URAC Accredited and as such (since Georgia doesn't ...
insurance coverage for barriatric surgery	1/23/2008
Q: I am significantly overweight and qualify for barriatric surgery however, my husband and I both ... A: Generally speaking, if a health insurer has something listed as an exclusion on their plan there ...
BCBS of GA and Mayo clinic	1/8/2008
Q: We have BCBS of GA PPO. Would my husband be covered if we went to the Mayo Clinic in Jacksonville, ... A: I apologize for my late response, I was on vacation last week and forgot to change my status to "on ...
change health insurance	12/17/2007
Q: I currently purchase my own health insurance and insure myself, my spouse and my daughter for $385 a ... A: The "discounted" rate is something you'd have to work out with the doctor in advance, or at least I ...
change health insurance	12/17/2007
Q: I currently purchase my own health insurance and insure myself, my spouse and my daughter for $385 ... A: Here are the answers to your questions.... 1. Yes, generally that is correct. 2. I'm not sure ...
medical bill	12/12/2007
Q: so know the collection agency it is calling me and telling me that they are going take me to court i ... A: Here is what I would recommend. Contact the hospital and work out a payment plan. Even if it is ...
health ins	12/4/2007
Q: I currently have Anthem-Matthew Thorton Blue through the company that I work for. I've been at the ... A: Sounds like you have done your homework! You are correct - COBRA is VERY expensive - but it may make ...
Hospital Bill	11/28/2007
Q: I am writing for my mother in law. She has received a hospital bill that see got when she had eye ... A: Can you answer the following questions for me? ** Does your mother-in-law have health insurance ...
cobra	11/28/2007
Q: I quit one company last month and got into this new company and subscribed to their Health ... A: I belive you probably can. However, for a definitive answer, you should contact the US Department ...
Harvard Pilgrim HMO	11/24/2007
Q: I am trying to find out what criteria are used to determine medical necessity for breast reduction ... A: Typically the HMO will not provide you in advance with the medical necessity criteria upon which ...
Pre -existing condition?	11/21/2007
Q: I am pregnant and my family is covered through my companies health insurance. I am thinking of ... A: LTD and STD are not my areas of expertise, but I can tell you what I know about it. Bear in mind I ...
Pre -existing condition?	11/20/2007
Q: I am pregnant and my family is covered through my companies health insurance. I am thinking of ... A: I am not an attorney, so please do not take this as legal advice. However, Per Title 31 (Maryland ...

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Crystal C. Carvotta-Brown

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Expertise

I can NOT answer questions about Medicare and Medicaid. I can answer questions about health insurance and benefits, preauthorization, utilization review, denials, approvals, medical necessity, case management, quality management, reimbursement strategies, managed care, URAC Accreditation, training, credentialing, etc.

Experience

I have been a registered nurse for the past 12 years, with the majority of that experience in the managed care and insurance industry.

Education/Credentials
I am a registered nurse (RN) with a bachelor of science in nursing and a masters of management in healthcare administration. I am a certified case manager (CCM), a certified rehabilitation registered nurse (CRRN), and a certified practitioner in healthcare quality (CPHQ).

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