Re: How to fight the system?-OT/vent

[Guest guest]

Hi . It's a long, hard fight but you can win. I don't know your

whole situation but I am curious about the dr. giving you referrals.

If you have a referral to a specialist from your primary dr. you

should call and make the appt. If there isn't a dr. in your area that

accepts your insurance then your insurance has to allow you to see

someone outside their plan. We went through this in Florida with our

neurologist. There were only two pediatric neurologists and neither

accepted our insurance. We had to pay up front but the insurance

reimbursed us. It took dozens of phone calls and hours of being on

hold but we finally got them to pay. Now, the neurologist did offer to

cut his fee in half if the insurance refused, which could be an

option. If you can't get the dr. to write the referral, go to the

office and demand one, don't wait for them to call you back. Will the

hospital not admit him for seizures? We stayed in the hospital 2 days

after Abbey's first seizure and the on-staff neuro gave us the

referral to an independent neuro.

I may be answering a question that you weren't asking but I hope this

helps a little. Just be a " royal pain " and they'll cave. I never

thought I could be so rude and demanding but if that's what it takes

to get attention then do it.

Good Luck

-- In Mito , wrote:

> Hi Everyone,

> I'm going to post this to all my different groups, so if you get it more

> than once I apologize.

> Will is 28 months old and having more and more problems. We had to

> switch Drs in Oct because our current one was no longer accepting

our state

> supported insurance. Our new Dr has no clue what to do for Will.

He has

> been having seizures since Nov. and they wouldn't do anything, I finally

> took him to the ER,last Tues., and he was started on meds. They were

> supposed to be working on getting him an EEG and referral to a

Neuro, none

> of this has happened yet. I have tried contacting them repeatedly

and am

> told they will call back, nothing. Now Will has had to stop the

meds and

> just had another seizure.

> What do I do? I tried calling the insurance, there is no one else

on the

> plan. I've tried arguing that with Will's special needs he has to

have a

> Pediatrician, or even just a competant Dr, but keep getting told

that this

> is the best they can offer. Who do I take this to? We are starting to

> write letters to our Politicians, but the way they work Will could

be grown

> or dead by then. I don't want to keep taking him to the ER, but it

is the

> only place he's getting any care right now. His current Dr is more than

> willing to write referrals but never follows them up, so they take

months to

> came through.

> Has anyone else had to deal with this? What do you do? How do you

get the

> care your child needs when the Dr is standing in the way?

> My Mom's so mad about all of this she's ready to call the medical review

> boards and really cause trouble. The problem is what then, there is no

> where else to go.

> I'm sorry this got longer than I planned, but I really don't know

what to do

> next.

>

[Guest guest]

Hi . It's a long, hard fight but you can win. I don't know your

whole situation but I am curious about the dr. giving you referrals.

If you have a referral to a specialist from your primary dr. you

should call and make the appt. If there isn't a dr. in your area that

accepts your insurance then your insurance has to allow you to see

someone outside their plan. We went through this in Florida with our

neurologist. There were only two pediatric neurologists and neither

accepted our insurance. We had to pay up front but the insurance

reimbursed us. It took dozens of phone calls and hours of being on

hold but we finally got them to pay. Now, the neurologist did offer to

cut his fee in half if the insurance refused, which could be an

option. If you can't get the dr. to write the referral, go to the

office and demand one, don't wait for them to call you back. Will the

hospital not admit him for seizures? We stayed in the hospital 2 days

after Abbey's first seizure and the on-staff neuro gave us the

referral to an independent neuro.

I may be answering a question that you weren't asking but I hope this

helps a little. Just be a " royal pain " and they'll cave. I never

thought I could be so rude and demanding but if that's what it takes

to get attention then do it.

Good Luck

-- In Mito , wrote:

> Hi Everyone,

> I'm going to post this to all my different groups, so if you get it more

> than once I apologize.

> Will is 28 months old and having more and more problems. We had to

> switch Drs in Oct because our current one was no longer accepting

our state

> supported insurance. Our new Dr has no clue what to do for Will.

He has

> been having seizures since Nov. and they wouldn't do anything, I finally

> took him to the ER,last Tues., and he was started on meds. They were

> supposed to be working on getting him an EEG and referral to a

Neuro, none

> of this has happened yet. I have tried contacting them repeatedly

and am

> told they will call back, nothing. Now Will has had to stop the

meds and

> just had another seizure.

> What do I do? I tried calling the insurance, there is no one else

on the

> plan. I've tried arguing that with Will's special needs he has to

have a

> Pediatrician, or even just a competant Dr, but keep getting told

that this

> is the best they can offer. Who do I take this to? We are starting to

> write letters to our Politicians, but the way they work Will could

be grown

> or dead by then. I don't want to keep taking him to the ER, but it

is the

> only place he's getting any care right now. His current Dr is more than

> willing to write referrals but never follows them up, so they take

months to

> came through.

> Has anyone else had to deal with this? What do you do? How do you

get the

> care your child needs when the Dr is standing in the way?

> My Mom's so mad about all of this she's ready to call the medical review

> boards and really cause trouble. The problem is what then, there is no

> where else to go.

> I'm sorry this got longer than I planned, but I really don't know

what to do

> next.

>

[Guest guest]

Hi . It's a long, hard fight but you can win. I don't know your

whole situation but I am curious about the dr. giving you referrals.

If you have a referral to a specialist from your primary dr. you

should call and make the appt. If there isn't a dr. in your area that

accepts your insurance then your insurance has to allow you to see

someone outside their plan. We went through this in Florida with our

neurologist. There were only two pediatric neurologists and neither

accepted our insurance. We had to pay up front but the insurance

reimbursed us. It took dozens of phone calls and hours of being on

hold but we finally got them to pay. Now, the neurologist did offer to

cut his fee in half if the insurance refused, which could be an

option. If you can't get the dr. to write the referral, go to the

office and demand one, don't wait for them to call you back. Will the

hospital not admit him for seizures? We stayed in the hospital 2 days

after Abbey's first seizure and the on-staff neuro gave us the

referral to an independent neuro.

I may be answering a question that you weren't asking but I hope this

helps a little. Just be a " royal pain " and they'll cave. I never

thought I could be so rude and demanding but if that's what it takes

to get attention then do it.

Good Luck

-- In Mito , wrote:

> Hi Everyone,

> I'm going to post this to all my different groups, so if you get it more

> than once I apologize.

> Will is 28 months old and having more and more problems. We had to

> switch Drs in Oct because our current one was no longer accepting

our state

> supported insurance. Our new Dr has no clue what to do for Will.

He has

> been having seizures since Nov. and they wouldn't do anything, I finally

> took him to the ER,last Tues., and he was started on meds. They were

> supposed to be working on getting him an EEG and referral to a

Neuro, none

> of this has happened yet. I have tried contacting them repeatedly

and am

> told they will call back, nothing. Now Will has had to stop the

meds and

> just had another seizure.

> What do I do? I tried calling the insurance, there is no one else

on the

> plan. I've tried arguing that with Will's special needs he has to

have a

> Pediatrician, or even just a competant Dr, but keep getting told

that this

> is the best they can offer. Who do I take this to? We are starting to

> write letters to our Politicians, but the way they work Will could

be grown

> or dead by then. I don't want to keep taking him to the ER, but it

is the

> only place he's getting any care right now. His current Dr is more than

> willing to write referrals but never follows them up, so they take

months to

> came through.

> Has anyone else had to deal with this? What do you do? How do you

get the

> care your child needs when the Dr is standing in the way?

> My Mom's so mad about all of this she's ready to call the medical review

> boards and really cause trouble. The problem is what then, there is no

> where else to go.

> I'm sorry this got longer than I planned, but I really don't know

what to do

> next.

>

[Guest guest]

,

I would call and schedule another appointment with his new pediatrician. I would speak directly in telling the ped. that you would gladly see the neurologist if he would call the neuro and follow through with the referral. If need be, call the neurologist that the ped is referring you to and tell them that you would like to make an appointment and have them help you with obtaining a referral. Be polite but persistent. In regards to your insurance company I would call and ask to speak to a supervisor or ask for the same contact person or case manager. Best of luck to you, Loriann