Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 It must be some special arrangements that has been put together between the states or the specific care is not available in your state. I am glad to hear that it has been available for you. They refused to pay since I could have surgery in our state even though the level of experience was vastly different. I went to the Mayo clinic and paid out of pocket and then waited the 5 months for my Medicare to kick in so I could finally have the surgery to take the pressure off of the cord. I had letters from my doctors about how rare my injury was and how serious it was but NO WAY with multiple appeals. I think I would be in a wheelchair if I had not gone to the more experienced surgery since the surgery has had poor outcomes for many. From: sudubo@... Date: Tue, 24 Jan 2012 20:56:27 -0800 Subject: Re: Re: Insurance Question My son's Medicaid pays 100% of his out of state care- doctors and hospitalizations and procedures. Sue From: Barbara Jimenez <mother5590@...> Subject: Re: Re: Insurance Question " " < > Date: Tuesday, January 24, 2012, 9:21 PM From experience and from working with National Patient Advocacy Foundation I can tell you that a Medicaid plan will not pay for out of state care. The GREAT purpose for medicare would be to pick up your deductibles and copays in Ca that your primary insurance does not pay. A provider cannot charge you beyond what your primary insurance pays if you show them your medical card. You may be able to get your primary insurance to pay if you can prove to them that the care is not available in your state but I do not think they will believe that in a state like California with the level of care available there at UCLA, Stanford and other BIG University Hospitals. Sadly with the way our system is right now the ability to get care in other states is almost impossible. It is all about saving money and so if you have the financial resources is the only way to get the care out of state except for a consultation. It might be worthwhile to contact IDF to help you find a specialist to help you for the problems you are having specifically. There may be someone better aware of how to deal with her needs on a consultant basis even in an out of state institution. It would take working with someone to advocate for you or having the labs etc drawn in CA and having someone consult from out of state such as at the Cleveland Clinic. Is there a Pediatrician or Immunologist that could help you get the answers you are seeking? Barbie Lucas with CVID, Bipolar etc BARBIE >________________________________ > From: Kookoo <nalla70@...> > >Sent: Tuesday, January 24, 2012 9:13 AM >Subject: Re: Insurance Question > > > > > >Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, > >Makenzie 11 > 22 > > >> >> > ** >> > >> > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, because >> > most of the time, Medicaid will cover our copays. We had to go >> > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't >> > cover any of it. If you are going to a " border " city, the hospital may >> > take your out-of-state Medicaid benefits, but you would have to actually >> > ask the providers if they will take it. Sorry... >> > >> > Mindy, mom to , 9, CVID+ >> > >> > > I have a random insurance question...andra (CVID, FG Syndrome) is >> > > under >> > > my husband's health insurance plan, since she is also a Regional client >> > > she >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any >> > > of >> > > you have both private insurance and state insurance. I am wondering if >> > > Medi-Cal would be more willing to finance referrals " outside of the >> > > system " ....I have no idea about any of this but we are desperately trying >> > > to get a referral to Cincinnati Children's. This has been dragging on >> > > for >> > > well over a year (maybe longer....I've lost track) now and we really >> > > cannot >> > > afford to finance the visit ourselves. Just wonder if anyone else has had >> > > experience with this. >> > > >> > > Thanks, >> > > >> > > Jeane >> > > Mom to andra 15 >> > > >> > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 They tried to deny it once, but my son's pediatrician wrote another referral and so he's been treated at Cincinnati Childrens Hospital quite a bit..We are very grateful for the wonderful care he has received there.....Our Medicaid agreed to pay 65% of what they were asking and the business lady at the hospital said that is more than they make from most private insurances so they have no problem with most out-of-state Medicaid insurances. Wow, Barbie, I'm sure glad you were finally able to get the surgery with the better surgeon. Something so serious as the spinal cord, yeah, the stakes are very high, must have the best skill. I personally think that different states should accept each others' state plans without any problem....this amazes me, because care varies so much....and aren't we the UNITED States of America?! ONE Nation, not 50. Anyway I'm glad you got the proper care, shame you had to wait so long though! Hugs Sue From: Barbara Jimenez <mother5590@...> Subject: Re: Re: Insurance Question " " < > Date: Tuesday, January 24, 2012, 9:21 PM From experience and from working with National Patient Advocacy Foundation I can tell you that a Medicaid plan will not pay for out of state care. The GREAT purpose for medicare would be to pick up your deductibles and copays in Ca that your primary insurance does not pay. A provider cannot charge you beyond what your primary insurance pays if you show them your medical card. You may be able to get your primary insurance to pay if you can prove to them that the care is not available in your state but I do not think they will believe that in a state like California with the level of care available there at UCLA, Stanford and other BIG University Hospitals. Sadly with the way our system is right now the ability to get care in other states is almost impossible. It is all about saving money and so if you have the financial resources is the only way to get the care out of state except for a consultation. It might be worthwhile to contact IDF to help you find a specialist to help you for the problems you are having specifically. There may be someone better aware of how to deal with her needs on a consultant basis even in an out of state institution. It would take working with someone to advocate for you or having the labs etc drawn in CA and having someone consult from out of state such as at the Cleveland Clinic. Is there a Pediatrician or Immunologist that could help you get the answers you are seeking? Barbie Lucas with CVID, Bipolar etc BARBIE >________________________________ > From: Kookoo <nalla70@...> > >Sent: Tuesday, January 24, 2012 9:13 AM >Subject: Re: Insurance Question > > > > > >Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, > >Makenzie 11 > 22 > > >> >> > ** >> > >> > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, because >> > most of the time, Medicaid will cover our copays. We had to go >> > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't >> > cover any of it. If you are going to a " border " city, the hospital may >> > take your out-of-state Medicaid benefits, but you would have to actually >> > ask the providers if they will take it. Sorry... >> > >> > Mindy, mom to , 9, CVID+ >> > >> > > I have a random insurance question...andra (CVID, FG Syndrome) is >> > > under >> > > my husband's health insurance plan, since she is also a Regional client >> > > she >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any >> > > of >> > > you have both private insurance and state insurance. I am wondering if >> > > Medi-Cal would be more willing to finance referrals " outside of the >> > > system " ....I have no idea about any of this but we are desperately trying >> > > to get a referral to Cincinnati Children's. This has been dragging on >> > > for >> > > well over a year (maybe longer....I've lost track) now and we really >> > > cannot >> > > afford to finance the visit ourselves. Just wonder if anyone else has had >> > > experience with this. >> > > >> > > Thanks, >> > > >> > > Jeane >> > > Mom to andra 15 >> > > >> > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 They tried to deny it once, but my son's pediatrician wrote another referral and so he's been treated at Cincinnati Childrens Hospital quite a bit..We are very grateful for the wonderful care he has received there.....Our Medicaid agreed to pay 65% of what they were asking and the business lady at the hospital said that is more than they make from most private insurances so they have no problem with most out-of-state Medicaid insurances. Wow, Barbie, I'm sure glad you were finally able to get the surgery with the better surgeon. Something so serious as the spinal cord, yeah, the stakes are very high, must have the best skill. I personally think that different states should accept each others' state plans without any problem....this amazes me, because care varies so much....and aren't we the UNITED States of America?! ONE Nation, not 50. Anyway I'm glad you got the proper care, shame you had to wait so long though! Hugs Sue From: Barbara Jimenez <mother5590@...> Subject: Re: Re: Insurance Question " " < > Date: Tuesday, January 24, 2012, 9:21 PM From experience and from working with National Patient Advocacy Foundation I can tell you that a Medicaid plan will not pay for out of state care. The GREAT purpose for medicare would be to pick up your deductibles and copays in Ca that your primary insurance does not pay. A provider cannot charge you beyond what your primary insurance pays if you show them your medical card. You may be able to get your primary insurance to pay if you can prove to them that the care is not available in your state but I do not think they will believe that in a state like California with the level of care available there at UCLA, Stanford and other BIG University Hospitals. Sadly with the way our system is right now the ability to get care in other states is almost impossible. It is all about saving money and so if you have the financial resources is the only way to get the care out of state except for a consultation. It might be worthwhile to contact IDF to help you find a specialist to help you for the problems you are having specifically. There may be someone better aware of how to deal with her needs on a consultant basis even in an out of state institution. It would take working with someone to advocate for you or having the labs etc drawn in CA and having someone consult from out of state such as at the Cleveland Clinic. Is there a Pediatrician or Immunologist that could help you get the answers you are seeking? Barbie Lucas with CVID, Bipolar etc BARBIE >________________________________ > From: Kookoo <nalla70@...> > >Sent: Tuesday, January 24, 2012 9:13 AM >Subject: Re: Insurance Question > > > > > >Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, > >Makenzie 11 > 22 > > >> >> > ** >> > >> > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, because >> > most of the time, Medicaid will cover our copays. We had to go >> > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't >> > cover any of it. If you are going to a " border " city, the hospital may >> > take your out-of-state Medicaid benefits, but you would have to actually >> > ask the providers if they will take it. Sorry... >> > >> > Mindy, mom to , 9, CVID+ >> > >> > > I have a random insurance question...andra (CVID, FG Syndrome) is >> > > under >> > > my husband's health insurance plan, since she is also a Regional client >> > > she >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any >> > > of >> > > you have both private insurance and state insurance. I am wondering if >> > > Medi-Cal would be more willing to finance referrals " outside of the >> > > system " ....I have no idea about any of this but we are desperately trying >> > > to get a referral to Cincinnati Children's. This has been dragging on >> > > for >> > > well over a year (maybe longer....I've lost track) now and we really >> > > cannot >> > > afford to finance the visit ourselves. Just wonder if anyone else has had >> > > experience with this. >> > > >> > > Thanks, >> > > >> > > Jeane >> > > Mom to andra 15 >> > > >> > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 Which state do you live in? The problem really is the contracts with Institutions within the states. The state writes contracts that include global care rather than fee for service in many cases and they want to keep the money within the state rather than giving it to other out of state Hospitals. There are often agreements with ajoining states so like NY with NJ or other small areas but BIG states are less likely to allow you to go somewhere else unless... the care is not available. I agree we are 50 states and Medicaid is a National Organization but it is ALL about money and contracts rather than what is BEST for the kid. Do you remember the baby that needed cardiac surgery and they would not allow the baby to go out of state to have the life saving surgery in a hospital that had MUCH BETTER outcomes? It did not happen until the media got a hold of it and there was pressure. That was just a few weeks ago. It is sad how many people have poor outcomes under these circumstances because they do not have the experience. Again I am so glad that you have been able to get it worked out. I have enough trouble getting care out of our county for our son because the state has contracts with certain providers that have networks for services. I have had to FIGHT FIGHT FIGHT to get his care in Seattle rather than locally. It is ridiculous. From: sudubo@... Date: Tue, 24 Jan 2012 21:44:59 -0800 Subject: RE: Re: Insurance Question They tried to deny it once, but my son's pediatrician wrote another referral and so he's been treated at Cincinnati Childrens Hospital quite a bit..We are very grateful for the wonderful care he has received there.....Our Medicaid agreed to pay 65% of what they were asking and the business lady at the hospital said that is more than they make from most private insurances so they have no problem with most out-of-state Medicaid insurances. Wow, Barbie, I'm sure glad you were finally able to get the surgery with the better surgeon. Something so serious as the spinal cord, yeah, the stakes are very high, must have the best skill. I personally think that different states should accept each others' state plans without any problem....this amazes me, because care varies so much....and aren't we the UNITED States of America?! ONE Nation, not 50. Anyway I'm glad you got the proper care, shame you had to wait so long though! Hugs Sue From: Barbara Jimenez <mother5590@...> Subject: Re: Re: Insurance Question " " < > Date: Tuesday, January 24, 2012, 9:21 PM From experience and from working with National Patient Advocacy Foundation I can tell you that a Medicaid plan will not pay for out of state care. The GREAT purpose for medicare would be to pick up your deductibles and copays in Ca that your primary insurance does not pay. A provider cannot charge you beyond what your primary insurance pays if you show them your medical card. You may be able to get your primary insurance to pay if you can prove to them that the care is not available in your state but I do not think they will believe that in a state like California with the level of care available there at UCLA, Stanford and other BIG University Hospitals. Sadly with the way our system is right now the ability to get care in other states is almost impossible. It is all about saving money and so if you have the financial resources is the only way to get the care out of state except for a consultation. It might be worthwhile to contact IDF to help you find a specialist to help you for the problems you are having specifically. There may be someone better aware of how to deal with her needs on a consultant basis even in an out of state institution. It would take working with someone to advocate for you or having the labs etc drawn in CA and having someone consult from out of state such as at the Cleveland Clinic. Is there a Pediatrician or Immunologist that could help you get the answers you are seeking? Barbie Lucas with CVID, Bipolar etc BARBIE >________________________________ > From: Kookoo <nalla70@...> > >Sent: Tuesday, January 24, 2012 9:13 AM >Subject: Re: Insurance Question > > > > > >Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, > >Makenzie 11 > 22 > > >> >> > ** >> > >> > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, because >> > most of the time, Medicaid will cover our copays. We had to go >> > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't >> > cover any of it. If you are going to a " border " city, the hospital may >> > take your out-of-state Medicaid benefits, but you would have to actually >> > ask the providers if they will take it. Sorry... >> > >> > Mindy, mom to , 9, CVID+ >> > >> > > I have a random insurance question...andra (CVID, FG Syndrome) is >> > > under >> > > my husband's health insurance plan, since she is also a Regional client >> > > she >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any >> > > of >> > > you have both private insurance and state insurance. I am wondering if >> > > Medi-Cal would be more willing to finance referrals " outside of the >> > > system " ....I have no idea about any of this but we are desperately trying >> > > to get a referral to Cincinnati Children's. This has been dragging on >> > > for >> > > well over a year (maybe longer....I've lost track) now and we really >> > > cannot >> > > afford to finance the visit ourselves. Just wonder if anyone else has had >> > > experience with this. >> > > >> > > Thanks, >> > > >> > > Jeane >> > > Mom to andra 15 >> > > >> > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 Which state do you live in? The problem really is the contracts with Institutions within the states. The state writes contracts that include global care rather than fee for service in many cases and they want to keep the money within the state rather than giving it to other out of state Hospitals. There are often agreements with ajoining states so like NY with NJ or other small areas but BIG states are less likely to allow you to go somewhere else unless... the care is not available. I agree we are 50 states and Medicaid is a National Organization but it is ALL about money and contracts rather than what is BEST for the kid. Do you remember the baby that needed cardiac surgery and they would not allow the baby to go out of state to have the life saving surgery in a hospital that had MUCH BETTER outcomes? It did not happen until the media got a hold of it and there was pressure. That was just a few weeks ago. It is sad how many people have poor outcomes under these circumstances because they do not have the experience. Again I am so glad that you have been able to get it worked out. I have enough trouble getting care out of our county for our son because the state has contracts with certain providers that have networks for services. I have had to FIGHT FIGHT FIGHT to get his care in Seattle rather than locally. It is ridiculous. From: sudubo@... Date: Tue, 24 Jan 2012 21:44:59 -0800 Subject: RE: Re: Insurance Question They tried to deny it once, but my son's pediatrician wrote another referral and so he's been treated at Cincinnati Childrens Hospital quite a bit..We are very grateful for the wonderful care he has received there.....Our Medicaid agreed to pay 65% of what they were asking and the business lady at the hospital said that is more than they make from most private insurances so they have no problem with most out-of-state Medicaid insurances. Wow, Barbie, I'm sure glad you were finally able to get the surgery with the better surgeon. Something so serious as the spinal cord, yeah, the stakes are very high, must have the best skill. I personally think that different states should accept each others' state plans without any problem....this amazes me, because care varies so much....and aren't we the UNITED States of America?! ONE Nation, not 50. Anyway I'm glad you got the proper care, shame you had to wait so long though! Hugs Sue From: Barbara Jimenez <mother5590@...> Subject: Re: Re: Insurance Question " " < > Date: Tuesday, January 24, 2012, 9:21 PM From experience and from working with National Patient Advocacy Foundation I can tell you that a Medicaid plan will not pay for out of state care. The GREAT purpose for medicare would be to pick up your deductibles and copays in Ca that your primary insurance does not pay. A provider cannot charge you beyond what your primary insurance pays if you show them your medical card. You may be able to get your primary insurance to pay if you can prove to them that the care is not available in your state but I do not think they will believe that in a state like California with the level of care available there at UCLA, Stanford and other BIG University Hospitals. Sadly with the way our system is right now the ability to get care in other states is almost impossible. It is all about saving money and so if you have the financial resources is the only way to get the care out of state except for a consultation. It might be worthwhile to contact IDF to help you find a specialist to help you for the problems you are having specifically. There may be someone better aware of how to deal with her needs on a consultant basis even in an out of state institution. It would take working with someone to advocate for you or having the labs etc drawn in CA and having someone consult from out of state such as at the Cleveland Clinic. Is there a Pediatrician or Immunologist that could help you get the answers you are seeking? Barbie Lucas with CVID, Bipolar etc BARBIE >________________________________ > From: Kookoo <nalla70@...> > >Sent: Tuesday, January 24, 2012 9:13 AM >Subject: Re: Insurance Question > > > > > >Not sure on all that, but I wonder how so many get their kids to even qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to anyone who knows ) I believe we make too much to qualify Makenzie for Medicaid (I think that is what she would get?) so we have insurance, but pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it gets very expensive, looking at my checkbook normal people would crap lol, > >Makenzie 11 > 22 > > >> >> > ** >> > >> > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, because >> > most of the time, Medicaid will cover our copays. We had to go >> > out-of-state (to Atlanta) for testing last year, and the Medicaid didn't >> > cover any of it. If you are going to a " border " city, the hospital may >> > take your out-of-state Medicaid benefits, but you would have to actually >> > ask the providers if they will take it. Sorry... >> > >> > Mindy, mom to , 9, CVID+ >> > >> > > I have a random insurance question...andra (CVID, FG Syndrome) is >> > > under >> > > my husband's health insurance plan, since she is also a Regional client >> > > she >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do any >> > > of >> > > you have both private insurance and state insurance. I am wondering if >> > > Medi-Cal would be more willing to finance referrals " outside of the >> > > system " ....I have no idea about any of this but we are desperately trying >> > > to get a referral to Cincinnati Children's. This has been dragging on >> > > for >> > > well over a year (maybe longer....I've lost track) now and we really >> > > cannot >> > > afford to finance the visit ourselves. Just wonder if anyone else has had >> > > experience with this. >> > > >> > > Thanks, >> > > >> > > Jeane >> > > Mom to andra 15 >> > > >> > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 25, 2012 Report Share Posted January 25, 2012 I did not make clear when I discussed the cost of going to Cincinnati, that we feel the $20,000 price tag was worth every penny!! Dr. Bleesing is wonderful, as were all of the doctors we saw. The entire staff was cheerful and accommodating. They made some significant changes to my son's diagnoses and treatments that have improved his quality of life. We are going back at the end of Feb. for follow-up. I am quite anxious to hear what diagnosis Dr. Bleesing is going to give my son after all of the tests he ran. Vickie Sent from my iPad On Jan 24, 2012, at 9:06 PM, Barbie Jimenez <mother5590@...> wrote: > > The good thing is that the immunologist is the one that is concerned. I would ask for a case manager with the insurance. Then.... I would explain the situation to the case manager and then..... I would ask the insurance what they need to follow the requests from the Immunologist. I would then.... go back to the Immunologist and ask VERY specifically what he thinks he needs for her care. If it is a referral to a specific place then he needs to write a letter. I would ask when you can pick it up etc. You will then find out if he is just talking or really feels you need to get more care somewhere else. Either way I would get a second opinion somewhere at a University setting or Childrens Hospital. YOU will have to be the one to orchestrate this because no one else will do it. IF..... the Care Manager does not seem to know what they are doing then I would go to the head of the department usually an RN. Then you go to the Medical Director. I have done this with several cases over the years and it will work. I am an RN as well as have worked with insurance companies. The last thing they want to do is have her get sicker. They may come back with an alternative place to be seen but that is OK just do it. I would appeal everything in writing following their guidelines. They will take it up the ladder since there is a process by law for appeals that go up the ladder. Feel free to contact me directly if I can help. Barbie > > > > > > From: maryjeanedavis@... > > Date: Tue, 24 Jan 2012 15:30:07 -0800 > > Subject: Re: Re: Insurance Question > > > > Thanks, Barbie for the information....I guess we will go back to the > > drawing board....unfortunately our pediatrician has washed her hands of > > helping me. We are currently trying to find another one. She was the one > > who struck the final death blow to our request to go to Cincinnati, she > > withdrew her support and told the insurance company that andra did not > > have a bone marrow failure issue, that her counts were stable (despite the > > evidence of all the CBC's/BMB that have been done). Our immunologist is > > the one pushing us to go for more opinions but when it comes right down to > > us getting a letter of support for this referral he has never produced one > > and has never been available to talk to the insurance company....the list > > goes on and on. I feel like I'm beating my head against the wall! > > > > Jeane > > > > On Tue, Jan 24, 2012 at 1:21 PM, Barbara Jimenez <mother5590@...>wrote: > > > > > ** > > > > > > > > > From experience and from working with National Patient Advocacy Foundation > > > I can > > > tell you that a Medicaid plan will not pay for out of state care. The > > > GREAT > > > purpose for medicare would be to pick up your deductibles and copays in Ca > > > that > > > your primary insurance does not pay. A provider cannot charge you beyond > > > what > > > your primary insurance pays if you show them your medical card. You may be > > > able > > > to get your primary insurance to pay if you can prove to them that the > > > care is > > > not available in your state but I do not think they will believe that in a > > > state > > > like California with the level of care available there at UCLA, Stanford > > > and > > > other BIG University Hospitals. Sadly with the way our system is right now > > > the > > > ability to get care in other states is almost impossible. It is all about > > > saving > > > money and so if you have the financial resources is the only way to get > > > the > > > care out of state except for a consultation. It might be worthwhile to > > > contact > > > IDF to help you find a specialist to help you for the problems you are > > > having > > > specifically. There may be someone better aware of how to deal with her > > > needs on > > > a consultant basis even in an out of state institution. It would take > > > working > > > with someone to advocate for you or having the labs etc drawn in CA and > > > having > > > someone consult from out of state such as at the Cleveland Clinic. Is > > > there > > > a Pediatrician or Immunologist that could help you get the answers you are > > > seeking? > > > Barbie > > > Lucas with CVID, Bipolar etc > > > > > > > > > BARBIE > > > > > > >________________________________ > > > > From: Kookoo <nalla70@...> > > > > > > > >Sent: Tuesday, January 24, 2012 9:13 AM > > > >Subject: Re: Insurance Question > > > > > > > > > > > > > > > > > > > > > > > >Not sure on all that, but I wonder how so many get their kids to even > > > qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to > > > anyone who knows ) I believe we make too much to qualify Makenzie for > > > Medicaid (I think that is what she would get?) so we have insurance, but > > > pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it > > > gets very expensive, looking at my checkbook normal people would crap lol, > > > > > > > >Makenzie 11 > > > > 22 > > > > > > > > > > > >> > > > >> > ** > > > >> > > > > >> > > > > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, > > > because > > > >> > most of the time, Medicaid will cover our copays. We had to go > > > >> > out-of-state (to Atlanta) for testing last year, and the Medicaid > > > didn't > > > >> > cover any of it. If you are going to a " border " city, the hospital may > > > >> > take your out-of-state Medicaid benefits, but you would have to > > > actually > > > >> > ask the providers if they will take it. Sorry... > > > >> > > > > >> > Mindy, mom to , 9, CVID+ > > > >> > > > > >> > > I have a random insurance question...andra (CVID, FG Syndrome) > > > is > > > >> > > under > > > >> > > my husband's health insurance plan, since she is also a Regional > > > client > > > >> > > she > > > >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do > > > any > > > >> > > of > > > >> > > you have both private insurance and state insurance. I am wondering > > > if > > > >> > > Medi-Cal would be more willing to finance referrals " outside of the > > > >> > > system " ....I have no idea about any of this but we are desperately > > > trying > > > >> > > to get a referral to Cincinnati Children's. This has been dragging > > > on > > > >> > > for > > > >> > > well over a year (maybe longer....I've lost track) now and we really > > > >> > > cannot > > > >> > > afford to finance the visit ourselves. Just wonder if anyone else > > > has had > > > >> > > experience with this. > > > >> > > > > > >> > > Thanks, > > > >> > > > > > >> > > Jeane > > > >> > > Mom to andra 15 > > > >> > > > > > >> > > > > > >> > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 25, 2012 Report Share Posted January 25, 2012 I did not make clear when I discussed the cost of going to Cincinnati, that we feel the $20,000 price tag was worth every penny!! Dr. Bleesing is wonderful, as were all of the doctors we saw. The entire staff was cheerful and accommodating. They made some significant changes to my son's diagnoses and treatments that have improved his quality of life. We are going back at the end of Feb. for follow-up. I am quite anxious to hear what diagnosis Dr. Bleesing is going to give my son after all of the tests he ran. Vickie Sent from my iPad On Jan 24, 2012, at 9:06 PM, Barbie Jimenez <mother5590@...> wrote: > > The good thing is that the immunologist is the one that is concerned. I would ask for a case manager with the insurance. Then.... I would explain the situation to the case manager and then..... I would ask the insurance what they need to follow the requests from the Immunologist. I would then.... go back to the Immunologist and ask VERY specifically what he thinks he needs for her care. If it is a referral to a specific place then he needs to write a letter. I would ask when you can pick it up etc. You will then find out if he is just talking or really feels you need to get more care somewhere else. Either way I would get a second opinion somewhere at a University setting or Childrens Hospital. YOU will have to be the one to orchestrate this because no one else will do it. IF..... the Care Manager does not seem to know what they are doing then I would go to the head of the department usually an RN. Then you go to the Medical Director. I have done this with several cases over the years and it will work. I am an RN as well as have worked with insurance companies. The last thing they want to do is have her get sicker. They may come back with an alternative place to be seen but that is OK just do it. I would appeal everything in writing following their guidelines. They will take it up the ladder since there is a process by law for appeals that go up the ladder. Feel free to contact me directly if I can help. Barbie > > > > > > From: maryjeanedavis@... > > Date: Tue, 24 Jan 2012 15:30:07 -0800 > > Subject: Re: Re: Insurance Question > > > > Thanks, Barbie for the information....I guess we will go back to the > > drawing board....unfortunately our pediatrician has washed her hands of > > helping me. We are currently trying to find another one. She was the one > > who struck the final death blow to our request to go to Cincinnati, she > > withdrew her support and told the insurance company that andra did not > > have a bone marrow failure issue, that her counts were stable (despite the > > evidence of all the CBC's/BMB that have been done). Our immunologist is > > the one pushing us to go for more opinions but when it comes right down to > > us getting a letter of support for this referral he has never produced one > > and has never been available to talk to the insurance company....the list > > goes on and on. I feel like I'm beating my head against the wall! > > > > Jeane > > > > On Tue, Jan 24, 2012 at 1:21 PM, Barbara Jimenez <mother5590@...>wrote: > > > > > ** > > > > > > > > > From experience and from working with National Patient Advocacy Foundation > > > I can > > > tell you that a Medicaid plan will not pay for out of state care. The > > > GREAT > > > purpose for medicare would be to pick up your deductibles and copays in Ca > > > that > > > your primary insurance does not pay. A provider cannot charge you beyond > > > what > > > your primary insurance pays if you show them your medical card. You may be > > > able > > > to get your primary insurance to pay if you can prove to them that the > > > care is > > > not available in your state but I do not think they will believe that in a > > > state > > > like California with the level of care available there at UCLA, Stanford > > > and > > > other BIG University Hospitals. Sadly with the way our system is right now > > > the > > > ability to get care in other states is almost impossible. It is all about > > > saving > > > money and so if you have the financial resources is the only way to get > > > the > > > care out of state except for a consultation. It might be worthwhile to > > > contact > > > IDF to help you find a specialist to help you for the problems you are > > > having > > > specifically. There may be someone better aware of how to deal with her > > > needs on > > > a consultant basis even in an out of state institution. It would take > > > working > > > with someone to advocate for you or having the labs etc drawn in CA and > > > having > > > someone consult from out of state such as at the Cleveland Clinic. Is > > > there > > > a Pediatrician or Immunologist that could help you get the answers you are > > > seeking? > > > Barbie > > > Lucas with CVID, Bipolar etc > > > > > > > > > BARBIE > > > > > > >________________________________ > > > > From: Kookoo <nalla70@...> > > > > > > > >Sent: Tuesday, January 24, 2012 9:13 AM > > > >Subject: Re: Insurance Question > > > > > > > > > > > > > > > > > > > > > > > >Not sure on all that, but I wonder how so many get their kids to even > > > qualify for state stuff? Does BCMH (in Ohio) cover CVID? This question to > > > anyone who knows ) I believe we make too much to qualify Makenzie for > > > Medicaid (I think that is what she would get?) so we have insurance, but > > > pay ALL copays, etc etc etc (( and have for her whole 11 years, yes it > > > gets very expensive, looking at my checkbook normal people would crap lol, > > > > > > > >Makenzie 11 > > > > 22 > > > > > > > > > > > >> > > > >> > ** > > > >> > > > > >> > > > > >> > My son has BCBS and Virginia Medicaid. THis works well in-state, > > > because > > > >> > most of the time, Medicaid will cover our copays. We had to go > > > >> > out-of-state (to Atlanta) for testing last year, and the Medicaid > > > didn't > > > >> > cover any of it. If you are going to a " border " city, the hospital may > > > >> > take your out-of-state Medicaid benefits, but you would have to > > > actually > > > >> > ask the providers if they will take it. Sorry... > > > >> > > > > >> > Mindy, mom to , 9, CVID+ > > > >> > > > > >> > > I have a random insurance question...andra (CVID, FG Syndrome) > > > is > > > >> > > under > > > >> > > my husband's health insurance plan, since she is also a Regional > > > client > > > >> > > she > > > >> > > qualifies for Medi-Cal....I have never used the Medi-Cal option. Do > > > any > > > >> > > of > > > >> > > you have both private insurance and state insurance. I am wondering > > > if > > > >> > > Medi-Cal would be more willing to finance referrals " outside of the > > > >> > > system " ....I have no idea about any of this but we are desperately > > > trying > > > >> > > to get a referral to Cincinnati Children's. This has been dragging > > > on > > > >> > > for > > > >> > > well over a year (maybe longer....I've lost track) now and we really > > > >> > > cannot > > > >> > > afford to finance the visit ourselves. Just wonder if anyone else > > > has had > > > >> > > experience with this. > > > >> > > > > > >> > > Thanks, > > > >> > > > > > >> > > Jeane > > > >> > > Mom to andra 15 > > > >> > > > > > >> > > > > > >> > > Quote Link to comment Share on other sites More sharing options...
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