United Brachial Plexus Network, Inc.

Im a mommy of a 3 1/2 year old boy that has rt hand/shoulder Brachial Plexus. I have been having non stop problems with my insurance Healthnet telling me that they dont approve out of state surgies. Im also having a problem from my sons peditrican stating that she is not allowed to do a refr, im trying hard to have her right it and fight with the insurance after. i was advised from another mom that there are families from California that or other states that has Healthnet and that they have approved, im sure after alot of fighting. Im asking if there is anyone out there than can share with me or would be willing to let me use thier names if it gets to wear im turned down time after time that I can give to Texas Childrens Hospital that George can use as amo to get us the appoval? im asking for help im very concerned. my son has had one surgery a yr ago and needs this last one and my insurance has stated that cant see the last Ortho/Surgeon and go to Occupation Therapy at childrens hospital in Los Angeles that i have been going to for the last 2 yrs and they say that the drs are not contracted and they are not giving me a different dr or can tell me where i can have my son see. I feel lost this is the first time my son has no dr watching or advising us on treatment for his injury. Healthnet has not made any effort to help and that is why i need others that have them to back me up. Thank you again, please help me. Thank you Lisa Phillips, Southern California

I am wondering if George would have that information of others who had the same insurance and were approved. He could just use it generically that others have been appoved and the insurance company would have access to the files or George could get them from his files, I am not sure it would be an issue of confidentiality between George and the insurance company using those names.

Yes, if George gave you the names, it would be an issue but he is just "reminding" them that they have approved others..

Just a thought..
Tami

i would read through my policy carefully, although i do not have health net i have encountered problems with coverage issues as well. sometimes i resort to yelling at the person i get on the phone from the insurance company, sometimes i threaten to have my attorney call and find out what the issues are and if they are not valid they would be held responsible for costs and possible injury as the result of with holding treatment that is covered in your policy. worst case senerio find a job with better coverage or pursude your company to find other insurance. sometimes people are lured in by the low cost of insurance when they don't forsee any potential problems but when they present its nice to know that you can get treatment. good luck to you and remember if you know that you are covered keep pursuing the matter they will eventually give in. i know it is such a shame that you have to battle for what you are paying for in the wake of a crisis, especially when you need to be putting your efforts elsewhere
good luck

I had HealthNet coverage back in 1999 (San Diego) when my daughter had her first at Texas Children's Hospital. Never had a problem. They didn't even do the automatic denial that most HMO's have in place. We had our pediatrician do the referral with some backup letters from doctors in San Diego and Texas, and everything was approved. On the other hand, my daughter is scheduled for her third surgery (Capsulodesis) under PacifiCare and we've been denied and have made little progress.

HI Derek's mommy - can you copy your post and put it on the General Message Board? that's where more moms with injured kids visit. Also - contact any support gorup people in California - they may also be able to help you with this... the list of support groups in in the awareness section http://ubpn.org/awareness
look in Worldwide Support Groups.

Good luck!
-francine