Need Help

[Jess & Kyle]

As some of you may remember, my husband was scheduled to have a nerve transfer performed by Dr Nath done on Wed the 3rd. Well, today we were informed that our insurance needs more info ~ they need all of his medical records, and then they will get another dr to look at them. They said that after looking over the pre-determination letter and reviewing the costs that Dr Nath was charging $50,000 over the customary charges they thought the surgery should cost. So, surgery has been postponed as we do not have the money to cover it if our insurance denies coverage of $50,000. We were told that the Mayo Clinic in Rochester may be in our "network" which would make the whole insurance issue easier. Has anyone dealt with them? Our insurance lady said a Dr by the name of Tiel?? (I can't remember if that is the correct name or not.) My husband is pretty down in the dumps about this, and so am I. We had so much hope and now it seems as though it is lost. Any advice will be greatly appreciated.

~Jessica

[lizzyb]

Hi Jess,

There is more info about Dr Tiel in the medical resources on this site. Have a look at the responses from Drs Kline and Tiel to UBPN's questionnaire http://ubpn.org/medicalresources/ls ... naire.html

As you can see, the BPI clinic there has been treating adult BPI for many years. Don't be too down in the dumps or disheartened about this, sometimes these things turn out for the best. Good luck; let us know how you get on.

Lizzy B :0)

[EllenB]

Here's what I can tell you about Mayo & my insurance. We have Blue Cross Blue Shield (GA), and they were willing to work with their counterpart (BC/BS-MN) in order to treat all expenses as in-network. I think Mayo is well respected enough that other carriers may have the same arrangement worked out.

We may be wrong in assuming this, but we think the overall costs are lower there because the doctors are actually employees of Mayo instead of in a private practice - thus on a salary.

If it helps, the total charges so far at Mayo (including preliminary tests, 2 operations that lasted over 10 hours each, 3 primary surgeons fully involved the whole time, all the other doctors involved in surgery i.e. anesthesiologist (sp??) etc, 11 days total post-surgery in hospital, four followup visits to Mayo including EMG & other tests )... is $147K. At this point, my total out of pocket has been ~$700, which I think is phenominal considering everything that's been done there - and of which I'm currently appealing ~$650!

Another ubpn poster recently emailed me the following after his Mayo surgery: "Oh, I got the hospital bill from Mayo today and 6 days and two surgeries (one 10 hr) was cheaper than one 1.5 hr surgery and 7 days in Huntsville Hospital. Something isn't right when my local hospital is more expensive than Mayo." His surgery also involved all three: Bishop/Shin/Spinner.

Hope that helps - email me privately if you have other questions.

Ellen

[EllenB]

PS because I'm so long winded... it might help you to know that these surgeries involved six nerve transferes (five for function, one for sensory), since John had all five nerves avulsed in the accident.

And now I'll shut up!

Ellen