Re: Dev. Ped. vs. Ped Neuro. Dr. Agin- should I or shouldn't I?

[Guest guest]

hi ,

Yes, the fee is $2,000. I just got a letter in the mail from Dr.

Agin's office confirming our appointment for January 25th. I am

going to cancel the appointment because I just can't justify spending

that kind of money for a few hours of time. To me it seems like a

racket, just like everyone else trying to take advantage of parent's

willing to do anything for their special needs children. Even if she

spent 4 hours with us (which I don't think is the case), that comes

out to $500 an hour!! I spoke to a parent that went to see her (she

had a different purpose-she needed a report from Dr. Agin stating

that the public school wasn't a good fit and letter stating that a

certain private school was teh only appropriate placement-she got the

placement which covers the $40,000 annual tuition). Maybe I am

wrong, but her fees just seem greedy to me. She doesn't take

insurance because then she would be limited to the rate approved by

the insurance company.

I found a great therapist that charges $65/hour (not yet approved for

insurance) and I figure that $2,000 will go a lot further working

iwth the therapist than padding Dr. Agin's pockets.

Tina

[Guest guest]

That seems a pretty harsh fee, especially for those who really cant

afford $2000 for an eval. Grant it she may be an amazing DR.

however, it always puzzles me why a good DR.in high demand would not

accept insurance. It is my personal feeling that if you really have

a desire to help the public, and have so much knowledge, why

eliminate so many people that can not afford services that pricey?

My mother once wanted me to go to a DR. that specialized in breasts

(Cancer and such) but she did not accept insurance. I absolutely

refused and went to someone in my plan, and got the same results. It

bothered me that she would not accept any insurance. I guess

eventually when they are in demand they feel that they can do what

they wish.

>

> hi ,

>

> Yes, the fee is $2,000. I just got a letter in the mail from Dr.

> Agin's office confirming our appointment for January 25th. I am

> going to cancel the appointment because I just can't justify

spending

> that kind of money for a few hours of time. To me it seems like a

> racket, just like everyone else trying to take advantage of

parent's

> willing to do anything for their special needs children. Even if

she

> spent 4 hours with us (which I don't think is the case), that

comes

> out to $500 an hour!! I spoke to a parent that went to see her

(she

> had a different purpose-she needed a report from Dr. Agin stating

> that the public school wasn't a good fit and letter stating that a

> certain private school was teh only appropriate placement-she got

the

> placement which covers the $40,000 annual tuition). Maybe I am

> wrong, but her fees just seem greedy to me. She doesn't take

> insurance because then she would be limited to the rate approved

by

> the insurance company.

>

> I found a great therapist that charges $65/hour (not yet approved

for

> insurance) and I figure that $2,000 will go a lot further working

> iwth the therapist than padding Dr. Agin's pockets.

>

> Tina

>

[Guest guest]

I agree! Supposedly she's good; but I'm sure there are plenty of other

" good " drs. around. My nuero-developmental pediatrician out of Children's

Hospital in Mountainside, NJ was very familiar with Apraxia and diagnosed

my son as such and recommended EFA's, multi-vitamin and OT for his

Hypotonia. So, Dr. Agin is not the only dr with knowledge of Speech Delay.

" tinamaried2003 "

<tdudek@...>

Sent by: cc:

@yaho Subject:

[ ] Re: Dev. Ped. vs. Ped Neuro. Dr. Agin- should

ogroups.com I or shouldn't I?

01/05/2006 02:29 PM

Please respond to

hi ,

Yes, the fee is $2,000. I just got a letter in the mail from Dr.

Agin's office confirming our appointment for January 25th. I am

going to cancel the appointment because I just can't justify spending

that kind of money for a few hours of time. To me it seems like a

racket, just like everyone else trying to take advantage of parent's

willing to do anything for their special needs children. Even if she

spent 4 hours with us (which I don't think is the case), that comes

out to $500 an hour!! I spoke to a parent that went to see her (she

had a different purpose-she needed a report from Dr. Agin stating

that the public school wasn't a good fit and letter stating that a

certain private school was teh only appropriate placement-she got the

placement which covers the $40,000 annual tuition). Maybe I am

wrong, but her fees just seem greedy to me. She doesn't take

insurance because then she would be limited to the rate approved by

the insurance company.

I found a great therapist that charges $65/hour (not yet approved for

insurance) and I figure that $2,000 will go a lot further working

iwth the therapist than padding Dr. Agin's pockets.

Tina

[Guest guest]

What amazes me is when people don't blink an eye when they are told

to pay cash out of pocket at the vet, as I just did this week. I

paid over $200 for a very short appointment to have the vet tell me

that my dog has a bladder infection and needs antibiotics! But when

it comes to their own health, or that of their families', the same

people don't think they should have to pay a $20 co-pay on meds or a

deductible for an ambulance ride. Or, sadly they think they have

the'right' to see any specialist they want, whenever they want,

because they have insurance.

In reality, I imagine that by not accepting insurance, Dr. Agin can

see fewer patients, give them better care, and not have to deal with

the headaches of dealing with insurance companies. She doesn't need

to overcharge the people with insurance in order to subsidize the

ones without. She doesn't have to pay one or two nurses to spend

the entire day on the phone with insurance complaints and pre-

approvals. She doesn't have to kiss up to primary care providers in

order to get their referrals. In short, she can do what she

probably loves and does the best - taking care of children and their

families.

It is harsh, but that is the reality of modern US medicine. She is

well-trained, in-demand, and by all accounts, worth every penny if

you can afford it. If you don't think she's worth it, there are

MANY other docs to chose from - no one says you have to see her.

She's not a philanthropist, she's a professional who has a unique

set of skills that, sadly, are in incredible demand. In a perfect

world, I agree we would all have access to wonderful physicians like

Dr. Agin, regardless of our ability to pay. But until we have

socialized medicine, that won't happen. And if (when?) we do end up

with socialized medicine, don't be surpised if there aren't enough

good doctors like her around anymore, or if you have to wait 2 years

to get in. Many other countries in the world already have this two-

tiered system of medicine - where the majority wait for the

specialty services they need, and the 'wealthy' pay cash, either

inside their country or travel to the US to get what they need.

Sad, but true-

>

> hi ,

>

> Yes, the fee is $2,000. I just got a letter in the mail from Dr.

> Agin's office confirming our appointment for January 25th. I am

> going to cancel the appointment because I just can't justify

spending

> that kind of money for a few hours of time. To me it seems like a

> racket, just like everyone else trying to take advantage of

parent's

> willing to do anything for their special needs children. Even if

she

> spent 4 hours with us (which I don't think is the case), that

comes

> out to $500 an hour!! I spoke to a parent that went to see her

(she

> had a different purpose-she needed a report from Dr. Agin stating

> that the public school wasn't a good fit and letter stating that a

> certain private school was teh only appropriate placement-she got

the

> placement which covers the $40,000 annual tuition). Maybe I am

> wrong, but her fees just seem greedy to me. She doesn't take

> insurance because then she would be limited to the rate approved

by

> the insurance company.

>

> I found a great therapist that charges $65/hour (not yet approved

for

> insurance) and I figure that $2,000 will go a lot further working

> iwth the therapist than padding Dr. Agin's pockets.

>

> Tina

>

[Guest guest]

What amazes me is when people don't blink an eye when they are told

to pay cash out of pocket at the vet, as I just did this week. I

paid over $200 for a very short appointment to have the vet tell me

that my dog has a bladder infection and needs antibiotics! But when

it comes to their own health, or that of their families', the same

people don't think they should have to pay a $20 co-pay on meds or a

deductible for an ambulance ride. Or, sadly they think they have

the'right' to see any specialist they want, whenever they want,

because they have insurance.

In reality, I imagine that by not accepting insurance, Dr. Agin can

see fewer patients, give them better care, and not have to deal with

the headaches of dealing with insurance companies. She doesn't need

to overcharge the people with insurance in order to subsidize the

ones without. She doesn't have to pay one or two nurses to spend

the entire day on the phone with insurance complaints and pre-

approvals. She doesn't have to kiss up to primary care providers in

order to get their referrals. In short, she can do what she

probably loves and does the best - taking care of children and their

families.

It is harsh, but that is the reality of modern US medicine. She is

well-trained, in-demand, and by all accounts, worth every penny if

you can afford it. If you don't think she's worth it, there are

MANY other docs to chose from - no one says you have to see her.

She's not a philanthropist, she's a professional who has a unique

set of skills that, sadly, are in incredible demand. In a perfect

world, I agree we would all have access to wonderful physicians like

Dr. Agin, regardless of our ability to pay. But until we have

socialized medicine, that won't happen. And if (when?) we do end up

with socialized medicine, don't be surpised if there aren't enough

good doctors like her around anymore, or if you have to wait 2 years

to get in. Many other countries in the world already have this two-

tiered system of medicine - where the majority wait for the

specialty services they need, and the 'wealthy' pay cash, either

inside their country or travel to the US to get what they need.

Sad, but true-

>

> hi ,

>

> Yes, the fee is $2,000. I just got a letter in the mail from Dr.

> Agin's office confirming our appointment for January 25th. I am

> going to cancel the appointment because I just can't justify

spending

> that kind of money for a few hours of time. To me it seems like a

> racket, just like everyone else trying to take advantage of

parent's

> willing to do anything for their special needs children. Even if

she

> spent 4 hours with us (which I don't think is the case), that

comes

> out to $500 an hour!! I spoke to a parent that went to see her

(she

> had a different purpose-she needed a report from Dr. Agin stating

> that the public school wasn't a good fit and letter stating that a

> certain private school was teh only appropriate placement-she got

the

> placement which covers the $40,000 annual tuition). Maybe I am

> wrong, but her fees just seem greedy to me. She doesn't take

> insurance because then she would be limited to the rate approved

by

> the insurance company.

>

> I found a great therapist that charges $65/hour (not yet approved

for

> insurance) and I figure that $2,000 will go a lot further working

> iwth the therapist than padding Dr. Agin's pockets.

>

> Tina

>

[Guest guest]

Bottom line here is that we need an accurate evaluation for these children. For

whatever reason (most likely money), it has been my unfortunate experience that

doctors who accept insurance spend about 15 minutes with a child and make a

decent guess at a diagnosis. They will not talk about the use of fish oil or

DAN doctors.

If you can find a good, reputable Doctor who accepts insurance, go for it.

Otherwise, I don't think we have a choice but to pay too much money for someone

who will do their job.

Diane <johnnyandmommy@...> wrote:

That seems a pretty harsh fee, especially for those who really cant

afford $2000 for an eval. Grant it she may be an amazing DR.

however, it always puzzles me why a good DR.in high demand would not

accept insurance. It is my personal feeling that if you really have

a desire to help the public, and have so much knowledge, why

eliminate so many people that can not afford services that pricey?

My mother once wanted me to go to a DR. that specialized in breasts

(Cancer and such) but she did not accept insurance. I absolutely

refused and went to someone in my plan, and got the same results. It

bothered me that she would not accept any insurance. I guess

eventually when they are in demand they feel that they can do what

they wish.

>

> hi ,

>

> Yes, the fee is $2,000. I just got a letter in the mail from Dr.

> Agin's office confirming our appointment for January 25th. I am

> going to cancel the appointment because I just can't justify

spending

> that kind of money for a few hours of time. To me it seems like a

> racket, just like everyone else trying to take advantage of

parent's

> willing to do anything for their special needs children. Even if

she

> spent 4 hours with us (which I don't think is the case), that

comes

> out to $500 an hour!! I spoke to a parent that went to see her

(she

> had a different purpose-she needed a report from Dr. Agin stating

> that the public school wasn't a good fit and letter stating that a

> certain private school was teh only appropriate placement-she got

the

> placement which covers the $40,000 annual tuition). Maybe I am

> wrong, but her fees just seem greedy to me. She doesn't take

> insurance because then she would be limited to the rate approved

by

> the insurance company.

>

> I found a great therapist that charges $65/hour (not yet approved

for

> insurance) and I figure that $2,000 will go a lot further working

> iwth the therapist than padding Dr. Agin's pockets.

>

> Tina

>

[Guest guest]

I do understand the questioning of why some MDs charge as much

as they do, but it's highly doubtful any will provide a breakdown.

Dr. Agin's letter that I just posted however does come pretty close

to doing just that. If you read it and think " I don't need that "

then there you go. Or don't go that is.

I once was sent as a birthday gift a consult with some color expert,

Kibbs or something, at a place called Metamorphosis about a

decade ago in NYC on 57th street and it was $1000 to meet with this

guy! Not hair color -but he tells you what " season " you are, what

colors you should wear, whether you are a " cool " or " warm " stuff

like that. I was a " theatrical romantic " or something. Not sure if

any of you know about what I'm talking about, I barely do -but 1000

dollars to learn I'd look best in pinks, whites, blacks, grays or

brights - not yellow beige or mustards, which I knew already if you

checked my wardrobe. I didn't ask for this as a present and I

thought it was outrageously expensive -but this guy apparently

consulted TV stars and if you had a consult with him you had to pay

for his time.

And also from NYC (where Dr. Agin's practice is by the way) I went

to some guy once who cut hair for celebrities but " only " charged me

and my friends 100 bucks because he was a friend of a friend. That

was a bargain for this guy even though I didn't like my cut (he cut

my bangs like 1/4 inch long which works for Vogue models I guess!)

'The world's most expensive haircut

Hadley Freeman

Thursday October 6, 2005

The Guardian

Leaving an anonymous-looking building in downtown Manhattan, a

phenomenally well-groomed man whispers, " Are you going upstairs? "

" Yes, " I hiss back furtively. " Enjoy. It's amaaaaazing. "

Three storeys up is a small white room, home to the beauty salon

Orlo, and the most expensive haircut in the world. If madam would

like a cut and blow-dry, madam will have to stump up $800 (£455).

May as well just pay a grand and use the change for tips, yeah?

Manhattan - where one can get a Botox-and-blow-dry lunch-hour

experience - is usually nonplussed about high-maintenance

treatments. But when news of the $800 haircut emerged, it has been

truly, er, plussed. The New York Times ran a cover story wailing in

horror and others have followed.

But, proving that New Yorkers really will pay anything for anything,

Orlo is thriving, and if the waiting list wasn't enough of a sign of

its success, then the fact that many Manhattan salons have bumped up

their own prices so as not to look paltry next to Orlo certainly is.

This is all due to the owner, the charming Orlando Pita. A regular

stylist for American Vogue, Pita has never before dealt with the

little people, previously limiting himself to fashion shows and

shoots. "

http://www.guardian.co.uk/g2/story/0,,1585890,00.html

But as expensive as they think that is for a haircut in the

US...How about just under $2000 in the UK -can they justify that?

(plus airfare and hotel of course for those of you not from the UK)

" $1,925 — Price of the world's most expensive haircut

London stylist Lee Stafford (above) gives it.

You get what he calls a " couture cut " — but you have to travel to

his house.

Of course, you'll get champagne, hors d'oeuvres and a follow-up trim

as part of your package, so actually it's quite reasonable.

Isn't it? "

http://www.bookofjoe.com/2005/02/_price_of_the_w.html

The point of my story is that if you want to take your child to a

well known MD (a medical doctor who is slightly more schooled than a

person who chooses who looks good in pink or can cut bangs 1/4 inch

long and make you look silly till they grow out) that you will most

likely have to pay more than you'll pay for an MD

who is not known. And while your questioning -again the Mccarton

Center charges 3 to 5 thousand dollars for an evaluation.

Yes some can afford to go and some can't -but don't go into the sour

grapes of an SLP alone is good enough. No way at all. I so so so

so so disagree that a good SLP and OT alone can in any way at all

compare to what a good neuroMD exam adds -again they can't diagnose

neurological soft signs. Most don't need to see a

neuroMD for the most part more than once or twice. They don't have

to be close to where you live, they are there however as a " hero " to

help your child if they need it and when they need it.

More powerful a " hero " than an SLP in almost all cases.

I appreciate that not all can afford to pay. I appreciate that

there are well known MDs that don't have time to see all that want

to see them. It's not a perfect world. If it was again they would

appreciate there is an epidemic problem going on with the rise in

speech impairments and speech issues would be taken more seriously

in medical school. Just like hearing impairments, like visual

impairments -speech impairments, especially apraxia, are

neurologically based.

Dr. Agin spent hours and years outreaching for free through CHERAB

so she is a philanthropist and she has a heart for the children.

It's her choice to what she charges and she chooses to spend more

time with each child which costs more. I also know she has seen

patients free of cost that are in dire situations and has worked

things out with others -but for the most part her rates are her

rates.

Below is an article that will perhaps explain why things are going

in this direction when it comes to medicine today.

CONNECTICUT NEWS

Dollars Will Get You The Doctor's Attention

`Concierge Medicine' Is A Trend That Some Love, And Some Wish Would

Disappear

January 1, 2006

By DIANE LEVICK, Courant Staff Writer

The doctor will see you now - for 1½ hours or more. He promises to

give you the most comprehensive exam you've ever had, answer all

questions unhurriedly, give you 24-hour access to him and make house

calls, if necessary.

Sound like a fantasy? Not if you can afford an annual $2,500

retainer. "

http://www.courant.com/news/local/hc-concierge0101.artjan01,0,2175480.story?coll\

=hc-headlines-local

=====

[Guest guest]

Abid,

I beg to differ...I took my son to a nuero-developmental pediatrician in

Children's Hospital in Mountainside, NJ and she was excellent. She knew

exactly what was wrong with my son...Apraxia, Hypotonia with perhaps

Language Processing Disorder. She also suggested additional Speech Therapy

aside from the therapy he was getting in his Special Ed Preschool; she

suggested OT for his Hypotonia. She gave me lots of suggestions to increase

his interaction since he paid her very little attention. She did not write

him off as autistic; she knew that he just didn't have the ability to

communicate. She recommended he be given Fish Oil with a Multi-Vitamin and

she wanted to see him in 6 months for a follow-up...So, saying all that;

there are plenty of other Drs. that are knowledgable and capable of both

diagnosing and treating your child who accept insurance; you just have to

do some research; talk to people; talk to your school's; talk to the Early

Intervention folks....

Myra

[Guest guest]

I think if the doc you see is open to or recommending fish oil it is a good

sign that they are aware of what's going on with apraxia. If they dismiss

it, you will probably not get what you need and should keep looking.

Our first developmentalist dismissed the possibility of benefits from fish

oil - and I was really looking for her expertise since we saw her 4 days

after starting it and I was witnessing dramatic improvements in mouth

movements & coordination. When I asked her about apraxia - she commented on

the fact that he could pucker...(but he just started doing it since the

oil) - and I should just give the motor delays some time. I got the " come

back in 9 months " - though speech was recommended, no real diagnosis - no OT

recommendations, no mention of low tone and we would have lost nearly a

year. We quickly sought out the second opinion. If you find a physician with

experience with apraxia in your area, you should be able to get the

help/info you need. But those who are not open-minded to the use of dietary

supplements just have not read the literature (scant as it is) or listened

to their patients. -

Re: [ ] Re: Dev. Ped. vs. Ped Neuro. Dr.

Agin- should I or shouldn't I?

Abid,

I beg to differ...I took my son to a nuero-developmental pediatrician in

Children's Hospital in Mountainside, NJ and she was excellent. She knew

exactly what was wrong with my son...Apraxia, Hypotonia with perhaps

Language Processing Disorder. She also suggested additional Speech Therapy

aside from the therapy he was getting in his Special Ed Preschool; she

suggested OT for his Hypotonia. She gave me lots of suggestions to increase

his interaction since he paid her very little attention. She did not write

him off as autistic; she knew that he just didn't have the ability to

communicate. She recommended he be given Fish Oil with a Multi-Vitamin and

she wanted to see him in 6 months for a follow-up...So, saying all that;

there are plenty of other Drs. that are knowledgable and capable of both

diagnosing and treating your child who accept insurance; you just have to

do some research; talk to people; talk to your school's; talk to the Early

Intervention folks....

Myra

[Guest guest]

, I am from Pennsylvania too and Amber also has the medicaid

supplemental insurance (and based on what I know, you will not get

reimbursed for any out of network expenses unless you get pre-

authorization, which is normally only given if the child's needs

can't be met with an in-network provider). We saw a neurologist

specializing in neuromuscular issues when amber was only 6 months to

a year (we started our journey with Amber having hypotonia and late

with all of her gross motor skills). While I did love our neuro, our

Geisinger HMO stopped being accepted at Hershey so we had to switch

hospitals (not sure if she would have helped me with speech anyway).

We then found Dr. Meyers, a neurodevelopmental pediatrician at

Geisinger, Danville, and I truly adore him. He spent so much time

with us that I was just amazed. But, his specialty is ADHD/autism

and not apraxia so part of me is wondering if we are missing

something. He did diagnose Amber as having " components " of apraxia

but I am not sure of the difference. I have no doubt that Amber has

apraxia (all of her SLP's have diagnosed her as such). She has all

of the classic signs-low tone in the mouth, lack of control over lips

and tongue, popping out a word and then never saying it again, losing

words if we don't repeat them over and over until they are etched in

her brain. He has been great at giving me scripts for all of the

therapies that he thinks Amber needs. But, as far as sending me to

an SLP specializing in apraxia, that hasn't happened (then again, I

dont' know if we have any in our area).

Honestly, after the last days of posts from and others, I am

even more torn up about whether or not to go see Dr. Agin. I was

really leaning towards not going, but now I don't know what to do.

Amber has been getting speech therapy since18 months (she is now 4.5)

and we are only talking in 1 to 3 word sentences. Would Dr. Agin be

able to point me in the right direction as to the type of therapy

that would best serve Amber (not looking for you to answer, just

thinking out loud!!LOL)? It certainly isn't frequency as we get

services 5 times a week (2x at school and 3x privately).

Unfortunately I don't live in or near a big city so our speech

therapy options are limited. While I like our therapists, I am not

qualified to judge their competence in working with apraxic children,

kwim. They both tell me that they work with other apraxic children,

but are they having any better success with them. I am going to look

at her letter now and see what type of therapy consultation she

provides (will she give me a therapy outline or something similar

that our SLP can follow or is she just going to tell me that she

needs therapy a certain number of times a week). And, is a one time

evaluation going to really help me if I can't afford to go back for

follow-ups (assuming that a follow up would also be $2,000-don't know

that for sure). Now is when I need that crystal ball which would tell

me that a. Yes, spending that money will change Amber's future or b.

nope, it won't. Then I would know for sure what to do!!

OK, I wasn't any help was I? I just wanted you to know that you

aren't alone in your struggle in knowing what is best to do for your

child. Trust yourself and your instincts and you will be fine. Now,

if I could only take my own advice!!

tina and Amber