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I want to know if there is a standard guideline for a gap waiver. I requested waiver because no in network provider in a 30 mile radius provides the same service. Ins denied waiver because there is an in network provider 42 miles away. What is the limit for mileage they can require a patient to travel for services?
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi Guest!
Great question. There is not a standard guideline we are aware of. From my understanding, it is the discretion of the insurance company. Most insurers we see set the radius at 30-40 miles, however I have run into an insurer in the past that set the radius at 75 miles!
I have seen success appealing this gap request denial for long distance travel - especially with sleep patients.
Hope this helps!
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