I need HELP

[Laura Barnes]

I am new to UBPN, and am looking for anyone who may know who or where I can go to get help to pay for my daughters upcoming surgery. Alyssa is scheduled for surgery in Houston with Dr. Nath to have the triangle tilt done on October 12, 2006, only his office called me today and he don't accept BCBS of TN or NM Medicaid. His office does not offer any assistance programs and I don't have the funding to pay for the surgery. Just to add to that the hospital don't accept NM Medicaid either. If anyone out there knows where I can start to apply for financial help I would greatly appreciate it. My home e-mail address is romantic_wbootsandjeans@yahoo.com

Thanks
Laura Barnes

[Carolyn J]

Welcome Laura,
You can look into Brachial Plexus Clinic at Shriner's Children's Hospital in Philadelphia(they have a web Site) There may be assistance with Airfare and Hotel & there is a Ronald McDonald's House nearby in NJ with a shuttle. They serve children without ANY charge.

I'm sure other parents will soon "chime in" here on your post.

God Bless you and your Dear Child.
Carolyn J
Adult LOBPI
age 68 & proud of it!


Message was edited by: Carolyn J

[Laura Barnes]

Thanks for your advice. I am however, really scared about going to anyone out side of houston. Call me weird but, houston hospitals and doctors have always been great to my daughter and Dr. Nath was the original doctor my daughter seen before going to Dr. Shanque (spellings probaly wrong). Thanks so much though

[admin]

BCBS will still pay as out of network and maybe even as in network since there are no other specialists who do this procedure at this time. Try to get a case manager involved at BCBS. You'll need a letter of medical necessity from Dr. Nath and you might have to go through an appeal process but many parents have been successful by being consistent and assertive and by going through one or more appeals.

Here are two other links as well

http://www.cerner.com/firsthand/

http://www.dcrf.com/

[admin]

We have bc and way back when Dr Nath and Dr Shenaq were both at Texas Children's. We were told Dr Nath would never operate on our son because of us having bc/bs so we looked into other doctors since we couldn't afford the one we wanted. Many people travel to Houston to see Dr Nath from all over, it's really not bad to travel else where to see another doctor. I think there is also a Shriner's in Houston that started doing bpi surgeries. The good thing is that you still have some time to decide what you want to do and get some money together before surgery if you decide to see Dr. Nath. I have heard others taking out loans or taking a second mortgage on their house. Take your time, do your research, then make your decision.

[kamren]

BC/BS of TN paid for my Mod/Quad 3 years ago. I got them to cover it because, although Dr Shenaq was out of network, they had no one in network that was a BPI specialist. It took a bit of work on my part, and on the part of the staff at Dr. Shenaq's office. But, in the end, BC/BS of TN stepped up to the plate.

You have to fight for it...but the results are worth it.

[april]

Dear Laura,

I have BCBS of Oregon. My son's TT surgery is schedule for Sept. 28th w/ Dr. Nath. This is his first surgery, and my first introduction into what it takes to get this surgery covered. Thanks to awesome parents that post on this message board and also Dr. Nath's forum, I have received such amazing support and helpful information as to how this whole crazy process works and how to get insurance companies to cover this much needed surgery. I will try to be brief. I would suggest you call BCBS and ask to get a CASE MANAGER assigned to you. Tell them you have a big surgery scheduled for your child, and must have a Case Manager. It might take a couple days for the CM to call you.... or, keep requesting until you get the call. Then, explain your story in detail w/ CM. Expect that they are not an expert on Erb's Palsy. Let them know that Dr. Nath is out-of network, but no one in your network does this surgery. So, you want it to be covered at in-network. Let them know you will be having Dr. Nath and your pediatrician fax a letter to them ( Dr. Nath can send the medical necessity letter). Have your pediatrician specifically state in the letter that there is no doctor in your area that does this surgery. Dr. Nath's office can help you with all of this. Your BCBS will have BCBS of Texas negoiate w/ you for your out-of network drs -- Dr. Kumar and Dr. Nath. You keep in CONSTANT contact w/ everyone -- it's a full-time job, if you ask me! Try to always be as professional and kind as possible even though for you it is such an emotional conversation. You can email me anytime-- april2123@yahoo.com I can only hope to be as helpful and supportive as these parents have been to me. Thankfully, after 5 weeks of struggle, we have a signed letter of agreement between Dr. Nath and it looks like all total w/ all facilities involved, what we will pay is sounding more and more "do-able" all the time. Thank you Jesus ! It's all going to be worth it. I know it in my heart.

Best Wishes to You and your family. Be strong. I'll be thinking of you. - April, mom to Zachary, 4 - ROBPI

[Carolyn J]

Good Luck Laura, and you and your son too, April.
Keep on Keepin' On---We UBPN Family are all behind you.
Please continue to keep us posted.
HUGS,
Carolyn J

[Laura Barnes]

Thank you everyone for the advice. I called on Friday and asked for a casemanager to be assigned to my case. I BCBS to cover Dr Nath out of network, now I have to start the appeals to get them to cover him in-network. This has been hard to deal with for alyssa's first two surgeries I didn't have to do anything because Texas Children's Hospital took the insurances that I had. My primary doctor is now asking me if the surgery in Houston is really necessary (we have a children's hospital in NM (Carrie Tingly Hospital) but alyssa was the first child they had ever seen with erbs and only one doctor there had ever even worked with a child with a brachial plexus injury (thankfully he is still our doctor) my primary wants to talk to all the doctors at the children's hospital to make her decision about whether or not there is an in-network doctor who thinks he can do the surgery. I hope all will work out.

Again thank you to everyone it has been a really good thing to see that I am not the only one out there going through this struggle.

Laura Barnes

[Laura Barnes]

Talk about happy and sad. Today at 7:30 BCBS of TN called and said alyssa's surgery was approved for in-network coverage. The two hours later the casemanager called and said that the company I work for don't wanna approve it foe in-network. I guess that they have to pay a part of the bill, they told BCBS to find a doctor in-network that could do the surgery. So here I go again tryinh to do appeals and tell them that Dr. Nath is who she needs to go to. Any advise????????????