Insurance fecking us...again!!!
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| Thu, 07-19-2007 - 9:38pm |
OMGFG!!! This is becoming a friggin' nightmare. When I lived in Md we always had hmo, sometimes bcbs sometimes Aetna. No matter what though we had great insurance; they even covered Liam's OT and Cian's speech. I am beginning to realize we were soooooo spoiled!
Dh works for the BOE in our county and we decided on another hmo, (bcbs). Well guess what, for everyday sniffles and generic rx they're great.....for anything else they suck @ss. Sorry to be so graphic, but I am boiling right now.
In the last year since we moved here, we have lost speech and OT for the boys and are depending solely on the school system. Liam gets speech as does Cian but I think to get OT you need to be wheelchair bound or have had a stroke,....not kidding. I was very fortunate with Liam that the schools picked up the slack and he gets a great deal from them. As Cian is still in pre-school we are having problems with him. He gets speech but they are resisting OT, and his only dx is significant developmental delays.
In previous posts I mentioned we need to get him evaluated, preferably by a dev ped. I look around; there are 4 dev peds locally....NOT ONE TAKES OUR INSuRANCE!!!! And a couple don't take ANY insurance. Oh but wait it gets better.....I call said ins provider to see if they have a dev ped on their books,....sure they do, here's his number, which rings and rings and rings. Look online and find 4 numbers for this guy; he has practiced in Boston, Atlanta and Chattanooga, and none of the numbers pick up or go to voice mail. btw: this ped graduated medical school in 1969, I'm beginning to think he's dead or retired.
Dh calls back ins co. They have no one else that is a dev ped who accepts this insurance.... arrrrghghgh!! They suggest we need to get a hold of one of the dev peds we have found an ask our reg hmo ped to request out of network coverage. BUT, it's not a given we may or may not get granted the petition. Who knows how long this will take The alternative is dropping $1,700 on a clinical psychologist I have heard good things about. He's local and will get to see Cian seen very soon. he does a full battery of tests over three 90 min sessions. The one dev ped who wanted $1,750 sees the parents for an hour, Cian for an hour and parents again for an hour. Basically dh calls him dx'r'us, lol. I just want it dealt with, but dh wants to hold out and see if the ins co. will allow us to see a dev ped out of network. Believe it when I flippin' see it.
Well tomorrow brings more phonecalls,....can't think why there's no milk in the fridge....sigh!
Dee







Awwww sweetie, I am there with ya on insurance co's!!! Now another thought... can you get coverage with a neuro-physcologist? They do the same battery of tests and maybe, just maybe *crossing fingers here* they will be covered for these tests?
You might want to call tomorrow and see. I sure hope so. I know I spent 2800 for Chris on his first doc and what I got was Dysgraphia, a visual processing disorder and just "Autistic Traits" ARGHHHH. You remember that one don't you?
Also here in cali we have something called "The regional center" where Chris is at now and its not costing a penny. Does your state have anything like that?
Lainie
Hi Dee,
We have never had insurance cover any of Malcolm's therapies and believe you me, we have tried. Right now we are needing to consider new re-evals and those will cost us alot more than what you are talking and again noone will take our insurance. We may be able to get new evals done by DOE for OT and Speech, I am thinking of trying to get more time for Malcolm on IEP as we likely will be continuing homeschooling, which means he is not getting the hours of help he would be getting in a school day...
Just wanted to let you know I feel your pain, darlin'
Sara
(((((Dee)))))),
Check out this article, and go kick some insurance bum!
http://www.cnn.com/2007/HEALTH/07/19/patient.insurance/index.html
-Paula
visit my blog at www.onesickmother.com
have you thought about a Ped Neuro route?
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(((Dee))) Insurance co's can be so frustrating! It seems like it takes an act of congress to actually talk to someone who knows what they're talking about and even then you end up getting the run around. HMO's are the worst. We had one at one time and it was like pulling teeth to get referrals. I hope you can get things worked out soon.
Amy
Hi!
I have BlueChoice HMO of Georgia and there are NO Developmental Pediatricians in the plan at all! However, we fought with them and got our Developmental Pediatrician approved for the rest of 2007. We will have to go through the whole process again next year.
We went for the evaluation in Jan. 2007 ($1,700)which we paid for with my husband's Flexible Spending Account. It is pre-tax money that is taken out of my husband's paycheck throughout the year for medical expenses not covered by insurance. Check and see if your (or your husband's)company has it. We had the Primary Care Provider and Developmental Pediatrician write letters stating the need for treatment. My husband was then very aggressive and kept calling Blue Cross and it worked! We have to send in the claim forms ourselves but it is worth it. I feel that my son is getting the medical care that he needs. I hope this helps!
Susan Sz. in Georgia
Mom to 6-year-old with Asperger's and 3-year-old so far so good
Susan, Thank you soooo much for your wonderful response. That is exactly what the BCBS rep on the phone suggested to us. We are calling the family doc Monday to get the ball rolling. I have also made two appt's with a clinical psychologist who specializes in dev delays and especially pdd. Good news is he can see Cian early Aug, bad news is it'll cost $1450. I have also looked into the neuropsych route and have some names and numbers to call Monday.
They are all afiliated with the same office and connecetd to the Children's hospital, whom Roan has already dealt with (cardiology) and ins was fine with that. In my heart of hearts I think he needs a dev ped, but at least with the clinical psych he gets 6 hours of evaluation as opposed to one.
Thanks again guys,
Dee
p.s where in ga are you?
We live in Roswell, Cobb County. Max will be starting first grade at Shallowford Falls Elementary. Where do you live?
Susan
Good gracious,
we are in Canton, Cherokee co. Dh works at Woodstock HS and Liam will be in 2nd grade this year at Holly Springs ES (although it's a self contained class k-3). We should think about coffee when the kids are in school!
Dee
p.s edited to add my birthday is March 9th, am also Pisces and have a 4 year old ds who acts more like a 3 yr old ; could be fate??!!! Lol
Edited 7/21/2007 10:00 pm ET by roanmom
Edited 7/21/2007 10:01 pm ET by roanmom
Looking forward to meeting you,
Susan