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HMO Hell!

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I posted a message about a month ago about medical care and cf

infants. Several people responded with the very good advice to find

a CFF Care Center. Unfortunately, the pulmonologist that the Cystic

Fibrosis Foundation has accredited in our area is very uninformed

about cystic fibrosis in infants. On our first visit he told us our

son only had a mild case of cf, that cpt is trivial if the child

stays active, and told me to " talk to my pediatrician about Zach's

acid reflux " because he only handles cf problems. My pediatrican

has stated bluntly that " CF is out of my league " .

He also did not even ask about Zach's enzyme dosage or his cpt

schedule. We eventually found out that Zach's enzyme dosage was too

low and he was having malabsorption issues, not acid reflux. I

immediately had my pediatrician do an out of network referral to a

pediatric pulmonologist. It was denied. We are appealing the

decision, but will not have an answer before Zach's next clinic

visit.

I am curious if it is possible to let someone at the Cystic Fibrosis

Foundation know that one of their " accredited " doctors is spouting

inaccurate information. I am sure this man is a qualified

pulmonologist, but he is not qualified to be treating cf infants. It

is because of this doctor's affiliation with the Foundation that the

insurance company will not consider it a medical necessity for Zach

to be treated elsewhere.

Am I wrong here? Any advice would be appreciated.

Sara - mommy to Zach 14 months wcf

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