Health Insurance

[april]

Dear Ivy,

I asked for a Case Manager from BCBS and dealt only with her and then, of course, w/ Dr. Nath's office. We had to prove that the TT Surgery was necessary and that it could not be done within a 100 mile area of where we lived. We provided those doctor's letters to BCBS and then the game began of working to get all the costs covered.... emg, hospital, dr. nath, etc. I worked on it for 3 months atleast a few hours per day to get the surgery approved at a preferred provider level. I did this prior to the surgery date. I'm sure it will be more difficult since the surgeries are already complete. My advice for you is to document every conversation -- date/time/person you spoke with -- and do as much as possible in writing, vs. telephone. You do have to be aggressive, but most importantly you have to be professional and present yourself as extremely organized. I wish you the best -- april

[tomp]

Everytime I log onto UBPN, I keep on seeing questions about Dr Nath and him not accepting insurance.

Just doing a search turns up pages of these questions.

UBPN Nath Insurance

Looks like there's something fishy going on here or is it just me?

[Mare]

With us it wasn't a case of Dr Nath not accepting ATENA it was that ATENA felt the mod quad was experimental even though its been done for over 10 yrs. After Dr Nath spoke with them they covered the surgery and he never said he didn't accept our insurance I do know they had to have a phone conference Dr Nath and ATENA to agree on his fee then he had them sign a letter of intent stating they would pay 100% and not bill the parents anything. I have heard though that others could not get surgery by him due to insurance problems but I don't know if it was his fault or the insurance's I've had problems with 3 insurance companies in the past trying to get them to cover surgeries and they were all different doctors and different hospitals.