United Brachial Plexus Network, Inc.

I'm trying to have mod quad surgery with Dr. Nath, but he is not part of my insurance network. If you have had mod quad surgery and had your insaurance approve Dr. Nath how did you do it?

We had to get out of network for Dustin's BPI. It was not Dr. Nath or Mod Quad but thought my experience might help. We called for approval and was told we needed a referral from his neurosurgeon. So, I had his neuro and physiatrist both send referrals. I explained to our insurance that he needed to see a specialist for this as his arm was flail and he was young and needed his arm functional. And to have any hope that the arm would work. Also that there was no qualified specialists in our insurance group and his neurosurgeon didn't do BPI surgery. I told them we wished to go to Mayo in MN. So, they took quite awhile to make a decision. And at the last minute said they needed to speak with the neurosurgeon. Good luck, I knew how hard he was to get a hold of. So I asked for the name of the Dr. in the insurance that was making this decision. The woman I had spoke to several times told me and I said good now the next person that will call will be my lawyer. I have your name and the Dr's. name. I said he planned to be a surgeon and lost wages and quality of life would be discussed. This was within hours of the time we should have been leaving for Mayo. She said , well you should also list the neurosurgeon, and I said I have his name, but he sent the referral as asked. No one from your office has seen my son. Low and behold as we were walking out the door the phone rings and he is pre-approved. It can be a headache but be persistent. I didn't threaten to sue the insurance as I knew that they usually have lawyers and more money than I did so they could drag it out forever and I would be broke. However to go after the person or people responsible would be easier as I didn't think the insurance would cover a personal suit against them. I am not quick to sue over things, but this is my son's future. We did everything asked and there was no reason to deny him the chance to have use of his arm. His appts were approved at our in house rate. Now I am just fighting to get them to pay what they had agreed. But, I am gaining.
Sue

Hang in there Sue!!! You've got the "Right Stuff".

HUGS on Halloween,
Carolyn J
Adult LOBPI