Owen (HMO Referrals)

[orabshire]

Our Med Group denied our claim to TCH because they said they can find someone in network to help my son. When asked who a week ago..they couldn't tell me.

We received a call Monday from the Med Group after I had my Doctor call and they are sending my son to Cedar Ciana to see a NeuroSurgeon. However, he is not a Pediatric Neuro and so my wife called the NeuroSurgeon's office and they said it would be a waste of our time! They don't treat Erbs Palsy!

Should I see him anyways to try to build a case again'st going to TCH? We have to submit an appeal soon! Our new appt. is April 28th at TCH.

[julie715]

Keep trying! We were denied at first, but got approval even though we DO have a brachial plexus clinic in our network. We said we felt we had a right to a second opinion from someone who specializes in this specific injury. We found language in our plan that says we have the right to this kind of consultation before deciding about surgery. TCH may be able to talk to your HMO on your behalf. Their insurance specialists were very helpful to us.

Make sure your HMO understands that not just any pediatric neuro knows how to treat BPIs!

Julie

[orabshire]

Owen saw our Neurologist today to prepare for his MRI tomorrow. When we told him taht our HMO referred us to someone that was not qualified. He said that is not who he referred us too. The Dr. he referred us to is out of network and that we MUST go out of network to find someone! My HMO/Medical Group is trying to send us to non-qualified Surgeons to prevent us from going out of network. This is becoming a big problem!

We do not trust our HMO. Should we trust that our Ped Neurologist actually found someone in CA that can perform the surgery? OR should we tell them we want to go to TX. With the war starting too, I'm afraid that transportation to TX might be an issue.

I need to fight for out of network anyways, but not sure if going to TX is a must or if our Ped Neuro found someone. He said the Surgeon knew about Erbs Palsy and could do it!

[Tammie]

Tell him you want to go to Texas! If transportation turns out to be an issue, you can always drive, take a train, whatever. Personally, I wouldn't go anywhere except for TX for the primary. They truly are the best. We talked to different surgeons before we went to TX and I'm so glad we went to TX. One thing, when they take the surreal nerve from the back of the leg, they cut three small horizontal slits to take the nerve. All the other surgeons talked about how they did it and it's a long vertical cut in the back of the leg down to the ankle. That's just one of the many things. Demand the best for your son. Good luck. Keep fighting!!!

[freddysmom]

Have you thought of taking your son to another center?
Scott Kozin at Shriners is extremely experienced at treating brachial plexus injuries and the treatment there is completely free of charge.
they too are getting wonderful results following primary surgeries - if you really can't get to TCH, why not give them a try? it's better than fighting a losing battle and running out of time. JMO

[orabshire]

Is this the one in CA? I heard there was one in CA, but don't know if it's the same free hospital.

[francine]

does Kozin do primaries? I thought he just does the orthopedic work?

[Tammie]

If you want to look into going somewhere else for the primary, you can call Dr. Kozin and ask him if he does that particular surgery (Shriners in Philly). They will pay to transport you there. It's a totally free hospital. There is Shriners in CA it's on the medical resource page.