I need HELP

[Tanya in NY]

Documentation, documentation, documentation. Make copies of it all. Keep a notebook by the phone and write down all conversations and names of people who you spoke with for future reference so you can look back if needed during this "battle of the insurance." Get Dr. Nath to write to the insurance company as well is my suggestion as HE, along with his staff, must have dealt with this before. Good luck.

Tanya in NY
Amber's Mom, ROBPI, almost 4 years old

[admin]

I wish I could offer some help to you. We fought our insurance company for 5 months to get surgery with Dr. Nath covered in-network. We finally gave up and scheduled surgery elsewhere. It just wasn't going to happen without us having to cover a huge amount of money ourselves. I hope you have more luck than we did! Best wishes to you.

[brandonsmom]

Laura, I would like to add here that if Dr. Nath has done any other surgeries for you, it would be considered continuity of care and that needs to be mentioned too. That is how we got our insurance company to budge !!!!! GAYLE

[orabshire]

Gayle, our son had primary and secondary surgery with Dr. Nath and now our insurance is trying to send us elsewhere for the triangle tilt. I want to know more about this continuity of care. We have Blue Shield HMO..hmmmm...

[brandonsmom]

See my other post under your post. Continuity of Care is used to fight insurance when the insurance tries to make you change Doctors for whatever reason. There are many more Doctors now that "DO" BPi surgeries, so they may feel to save money they don't want the first doctor to do surgeries....the fight is that your child has already seen this doctor.....the child already "KNOWS" this doctor and the doctor already knows the child.....CONTINUITY of CARE. This happened to me earlier this year.....the doctor dropped in- network coverage for my healthcare....I did not want to pay for out-of -network coverage, but I didn't want to leave my doctor that I have been seeing for 5 years....(I HAVE A LIST OF MEDICAL PROBLEMS TOO LONG TO MENTION) I played the continuity of care card and I still only pay my in network co-pay and they pay him what he deserves to be paid....GAYLE

[angelsmom]

Dr. T.S. Park in St. Louis Missouri takes medicaid
If you need the site or phone number just post

[ZaidraZavian]

We had BCBS of Louisiana for Zavian's surgery and they paid, even for out of network. However, I have taken Zavian to Philadelphia's Brachial Plexus Clinic and that was absolutely FREE. She saw Dr.Kozin, hand surgeon, and is scheduled to return in late January 2007. Zavian has had all surgeries in Houston by Drs.Laurent(deceased), Nath and Shenaq and she currently still sees Shenaq. But, please, do not limit the care for you child because of the insurance failing to pay. There are alternatives out there. I definitely understand where you are coming from. I wish you and your child the best of luck.

[Laura Barnes]

What surgeries has your child had. What surgeries do they do at the Philadelphia clinic. I am under the impression that Dr. Nath is the only one who does the triangle tilt, am I wrong?? Is Dr. Shenaq still doing surgeries, if so where. Dr. Shenqa was Alyssa's doctor for her first two surgeries but, when I tried to contact him after TCH shut down the BPI clinic I keep running into deadends. Can you post the # to contact Dr. Shenaq as well as the Philiy clinic, I would be Very thankful.

Laura
Mother of Alyssa

[Laura Barnes]

On a different note, BCBS of TN has approved in-network coverage but, my corporate office denied the approval and wants more proof about - there not being any in-network doctors who can do the surgery. My caseworker from BCBS forwarded several documents to my corporate office today as well as my appeal, I should have another answer by Friday.

My day had one huge relief though, as I was driving to work today Southwest Airlines called me and told me they were going to donate two round trip tickets from NM to Houston for me and Alyssa, they also said that I have a year to use them (that will save me almost $1000.00), so if the insurance mess isn't fixed by Oct. 9th (we have to be in houston the morning of the 10th for the pre-op appts) and I have to reschedule, atleast the airplane tickets are covered.

Laura
Alyssa's Mom

P.S.
Thank you to everyone for your help.