Dev Ped update...sorta

iVillage Member
Registered: 04-28-2007
Dev Ped update...sorta
2
Fri, 07-20-2007 - 6:46pm

Well we called the other dev peds and nope, they don't take ins either and want $1700 for three hours (1 with parents, 1 with Cian, 1 with parents again). I called the clinical psychologist who is a specialist with Aspergers and other ASD's as well as behavioral dx and got Cian in on Aug 10th and 16th. 3 hour sessions each time; legitimate evaluations and assessments. He is also a "mere" $1450; $250 less and more contact time,...freaky. We are calling reg ped on Monday to let him know our issues and for him to ask ins for out of network coverage. At best they'll cover 50% at worse they'll deny the claim. But after reading the excellent link Paula sent me, I think I'm just going to appeal, appeal appeal!!!

Dh was all set to change to a ppo in the fall (open season). Thing is with ppo here our deducatbles are higher as are co-pays and what is eventually covered. Not to mention dh is on 3 meds, Liam on 2 and I'm on 1. Right now all combined it's $130 per month, before reg everyday stuff for the kids sniffles etc); on ppo it's be more in the $200 range.) We are scraping ends meet as it is.

I may be able to ask my parents for help with the fee for Cian. I hate to; I've never asked for anything snce we got married, but he's my baby; I need to swallow whatever pride I have left.

Ugh, dammit, after $1450 I better get the kid dx with something, lol....kidding

Dee

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iVillage Member
Registered: 06-25-2003
Fri, 07-20-2007 - 7:41pm

Dee,


How about local universities?


One of Peter's evals was done at Hofstra, by

-Paula

visit my blog at www.onesickmother.com
iVillage Member
Registered: 04-07-2003
Fri, 07-20-2007 - 8:09pm

I underdstand where you are coming from. We have been really thinking hard about changing our insurance to a PPO instead of the bare minimal HMO we have now. There are no one fee for scripts. They will only pay a smalll percentage for the meds. They won't let you visit the specialists you want. Only who is in their book, you can't go out of network at all or they won't cover it.

Remmeber Josh has multiple problems.I know when we do more surgery on his foot it is going to cost us more than an arm and a leg just to cover the stuff not cover under the current plan.We learned this after he had broken his leg. What is considered durable and what isn't. Also what they considered In-home PT versus not. We had PT after Josh broke his leg and it would hav continued, but we managed to get Josh to school, so he was no longer considered House bound. So no more in house PT. and the insurance wont cover Outside PT clinics. The Ortho who took care of Josh's leg consulted with a Ped Ortho(who never charged us Thank you) but when we wanted to go to the Ped Ortho to make sure everything was going well as a 2nd opinion while the leg was healing, the insurance would not cover the bill. Josh's has a clubfoot and the insurance does not understand that clubfoot is an Ortho problem but a very specialized one. Not every Orthopedic surgeon can handle/fix a clubfoot. And the insurance didn't give a darn

We are also starting to find out because the insurance company is not well meeting its obligations with its doctors properly, some of the doctors we use or may need in the future are dropping that insurance company. Right now it affected my Gyn, and the kids Opthomologist. Who is next?

Another issue is becareful about how your MD bills you or who or from where. When Josh used his Devlopmental Ped out of her Hospital clinic office 5 minutes from here. They billed us through the Hospital's billing system. So even though it was a MD office appointment. The insurance company would not cover the bill because it was a hospital visit/bill which they cover differently than a MD office visit. Confused yet? I still am.

Fortunately Our Dev Ped has another offfice that does not bill through the hospital so we switched our visits to the other office where it is only coosting us the co-pay. The problem is that this office is now 20-30 minutes away from us. For many of you it may not be an issue because you travel further than that routinly. But the orginal office was only 5-10 mins. Appointments could be made towards the end of the day or 1st thing and during the school year not affect Josh going to school. The new office harder to get the later appointments and Josh ends up missing school. Plus Gas is not cheap here .Ugh

Rina