RE: [SPAM] Re: Spect Scan / Blue Shield

[Guest guest]

My boys (2 of them) got scans (2 of them) done at SMI. The first time was

in 2004. At that time I was not at all prepared for the amount I was to pay

after insurance (I have BC PPO, individual policy). It would have been nice

to have that info before the appointment. The MRI place downstairs from SMI

got all of my insurance info before hand and only asked for me to pay my

portion of the bill at the appointment. In fact, if you need to go to SMI,

I would insist that they price the procedure out for you and inform you of

your portion of the cost - or you get in touch with your insurance with the

codes that SMI is going to use on the claim.

However, I was told about the up-front money for the anesthesiologist. As

much as I didn't like it, I knew that I would be reimbursed for some of that

cost. The problem was trying to get the in-network provider (Dr. Mandel is

a contracted provider for BC) savings portion back from the

anesthesiologist! That took almost 8 months!

The second time my boys received scans at SMI, one of my sons had qualified

for Medi-cal as a secondary insurance. SMI is (at least in Dec. 2006) a

Medi-cal provider. The problem was that the front office did not submit the

claim to Medi-cal correctly - as a secondary insurance, and made no effort

to correct the situation for months. It took me months to sort out the

problem, request SMI to resubmit, etc. I would have done it myself except

that at the time I was told that only the provider can submit a claim. The

claim that was submitted to BC for my other son was denied payment due to

lack of prior authorization - that was a first. In the EOB that I received,

it was documented that the amount submitted was NOT the responsibility of

the patient as the provider was contracted provider and was bound to the

contract. I tried to work with SMI providing them with BC contact names and

number, Medical contact names and numbers, answers to specific

issues/problems and what they needed to do to resolve the problem, etc. I

got NO cooperation from SMI's front office/billing person. I did not pay

anything to SMI until they resolved the contract issues/payments/coverage

with BC.

Anyway, the long and short of it is, I will NOT go back to SMI. The person

in the front office is lazy and has no desire to work with you to resolve

problems. If Dr. G wants my boys to have scans in the future then we will

need to find a different imaging service to perform the scans. If you are

to use SMI, or anyone else for that matter, I strongly encourage you to do

your procedure, coverage, cost research up front. Talk with your insurance

company regarding scan, scan prep, post-scan, and anesthesiology procedures

and costs - providers should be able to tell you ahead of time what the

procedure codes are. If the anesthesiologist is in your network, find out

what the patient savings is for using an in-network provider for the

procedure performed and subtract out any patient savings from your payment

to him.

I'm sorry to paint such a bleak picture on something that can provide Dr. G.

with vital information on our kids, but scans are not cheap and like each of

you, I don't have the spare time to do all the run around again.

Patti

_____

From: [mailto: ] On Behalf Of Robyn

Sent: Tuesday, June 03, 2008 6:05 PM

Subject: [sPAM] Re: Spect Scan / Blue Shield

I thought it was Brain Matters at the UCLA Harbor Medical Center, but

they don't take insurance either.

> > I would not recommend Santa Imaging. Does BS give you any

other

> > facilities that can do the Spect? I saw Dr. Amen from the Amen

> > Clinic give a

> > lecture, and if my son has another spect scan, I will try to have

> > it done

> > there. Maybe you can get recommendations from other families?

> >

> > BS did cover part of my son's spect scan. What SMI failed to

> > mention to me

> > when I set everything up was that the anesthesiologist is a

> > freelancer (did

> > not find this out until AFTERWARDS) and he wanted $800 cash at

the

> > end of

> > the procedure. Very, very weird.

> >

> > SMI did not provide any kind of interpretive report, and if I

> > wanted copies

> > of the images, they were another $45 each.

> >

> > Kristy

> >

> > From: groups (DOT) <mailto:%40> com

[mailto:groups (DOT) <mailto:%40> com] On

Behalf

> > Of Cheryl

> > Lowrance

> > Sent: Tuesday, June 03, 2008 1:24 PM

> > groups (DOT) <mailto:%40> com

> > Subject: Spect Scan / Blue Shield

> >

> > We'll probably be going in for a Spect Scan in a few months so

right

> > now, and I are trying to figure out how to make this as

> > easy as possible as far as finances go. I've contacted my

insurance

> > co Motion Pic/BS and they've told me that as long as it's ordered

by

> > an MD and is medically necessary, it will be covered. The problem

> > I'm running into is if Santa Imaging is a BS provider. My

> > insurance company is saying they are out of network. Dr. Uszler

will

> > be covered, but SMITA will not and they will only cover 70% of the

> > " allowed " amount. Basically, she told me it's going to cost me a

> > lot. I can't afford it if it does. Does anyone know if SMITA is or

> > isn't a BS provider? Anyone with BS been through it already? With

a

> > BS provider she said it would be covered 100%. Of course, Dr. G

> > won't let us go anywhere else. If we can't afford it, we simply

> > can't get it done.

> >

> > Cheryl

> >

> >

[Guest guest]

Thanks for the info. I've spent all day today dealing with this

issue so I could go ahead and get it pre-authorized. My insurance

company told me that it doesn't have to be pre-authorized but because

of the cost, it was highly suggested to me to do so anyway so I don't

have any surprises. The pre-authorization is good for one year so I

should be good for whenever he wants to order it since I know he

plans to order one within the next few months.

I also called Cedars to ask about their SPECTs. They told me that

any doctor can order a SPECT from them as long as they are licensed.

Since they are a provider for my insurance, it will be covered 100%,

I just need to make sure the anesthesiologist and the radiologist are

also contracted with my insurance. So I decided that I could get it

done there, have it interpreted by Dr. Uszler (he also takes our

insurance so I have a question out to them right now if I have to pay

upfront - which as someone else mentioned, is a violation of his

contract). I ran this by and she told me I needed to talk

to Dr. Uszler to see if that's acceptable to him as she didn't know

if the procedure was actually done a special way and/or if Cedars did

it the same way. When I called SMI, I was told that she didn't know

how Cedars did it but Dr. Uszler takes several pictures. I asked her

how many and she told me 4-6 so now I know to make sure they take

multiple pictures. She also called me back after speaking to Dr.

Uszler that if I go to Cedars, I should ask for the raw data on an

optical disc and he will reprocess it himself. So it looks like this

is an acceptable solution to all and now I'm just waiting to hear if

it's acceptable to Dr. G.

I've worked very hard on finding a solution that should,

theoretically, make everyone happy and get what needs to be done,

done. If this doesn't work, then I guess we get no SPECT. At least,

not ordered from Dr. G. It's unreasonable to ask anyone to pay out

of pocket for such an expensive thing when it can be covered by

insurance *somewhere*. I just don't have that kind of money lying

around I really feel that we are at a point where it's practically

essential to make the proper changes given the current state of my son.

Cheryl

On Jun 3, 2008, at 7:21 PM, PATRICIA SWEETMAN wrote:

> My boys (2 of them) got scans (2 of them) done at SMI. The first

> time was

> in 2004. At that time I was not at all prepared for the amount I

> was to pay

> after insurance (I have BC PPO, individual policy). It would have

> been nice

> to have that info before the appointment. The MRI place downstairs

> from SMI

> got all of my insurance info before hand and only asked for me to

> pay my

> portion of the bill at the appointment. In fact, if you need to go

> to SMI,

> I would insist that they price the procedure out for you and inform

> you of

> your portion of the cost - or you get in touch with your insurance

> with the

> codes that SMI is going to use on the claim.

>

> However, I was told about the up-front money for the

> anesthesiologist. As

> much as I didn't like it, I knew that I would be reimbursed for

> some of that

> cost. The problem was trying to get the in-network provider (Dr.

> Mandel is

> a contracted provider for BC) savings portion back from the

> anesthesiologist! That took almost 8 months!

>

> The second time my boys received scans at SMI, one of my sons had

> qualified

> for Medi-cal as a secondary insurance. SMI is (at least in Dec.

> 2006) a

> Medi-cal provider. The problem was that the front office did not

> submit the

> claim to Medi-cal correctly - as a secondary insurance, and made no

> effort

> to correct the situation for months. It took me months to sort out the

> problem, request SMI to resubmit, etc. I would have done it myself

> except

> that at the time I was told that only the provider can submit a

> claim. The

> claim that was submitted to BC for my other son was denied payment

> due to

> lack of prior authorization - that was a first. In the EOB that I

> received,

> it was documented that the amount submitted was NOT the

> responsibility of

> the patient as the provider was contracted provider and was bound

> to the

> contract. I tried to work with SMI providing them with BC contact

> names and

> number, Medical contact names and numbers, answers to specific

> issues/problems and what they needed to do to resolve the problem,

> etc. I

> got NO cooperation from SMI's front office/billing person. I did

> not pay

> anything to SMI until they resolved the contract issues/payments/

> coverage

> with BC.

>

> Anyway, the long and short of it is, I will NOT go back to SMI. The

> person

> in the front office is lazy and has no desire to work with you to

> resolve

> problems. If Dr. G wants my boys to have scans in the future then

> we will

> need to find a different imaging service to perform the scans. If

> you are

> to use SMI, or anyone else for that matter, I strongly encourage

> you to do

> your procedure, coverage, cost research up front. Talk with your

> insurance

> company regarding scan, scan prep, post-scan, and anesthesiology

> procedures

> and costs - providers should be able to tell you ahead of time what

> the

> procedure codes are. If the anesthesiologist is in your network,

> find out

> what the patient savings is for using an in-network provider for the

> procedure performed and subtract out any patient savings from your

> payment

> to him.

>

> I'm sorry to paint such a bleak picture on something that can

> provide Dr. G.

> with vital information on our kids, but scans are not cheap and

> like each of

> you, I don't have the spare time to do all the run around again.

>

> Patti

>

> _____

>

> From: [mailto: ] On Behalf

> Of Robyn

> Sent: Tuesday, June 03, 2008 6:05 PM

>

> Subject: [sPAM] Re: Spect Scan / Blue Shield

>

> I thought it was Brain Matters at the UCLA Harbor Medical Center, but

> they don't take insurance either.

>

>

> > > I would not recommend Santa Imaging. Does BS give you any

> other

> > > facilities that can do the Spect? I saw Dr. Amen from the Amen

> > > Clinic give a

> > > lecture, and if my son has another spect scan, I will try to have

> > > it done

> > > there. Maybe you can get recommendations from other families?

> > >

> > > BS did cover part of my son's spect scan. What SMI failed to

> > > mention to me

> > > when I set everything up was that the anesthesiologist is a

> > > freelancer (did

> > > not find this out until AFTERWARDS) and he wanted $800 cash at

> the

> > > end of

> > > the procedure. Very, very weird.

> > >

> > > SMI did not provide any kind of interpretive report, and if I

> > > wanted copies

> > > of the images, they were another $45 each.

> > >

> > > Kristy

> > >

> > > From: groups (DOT) <mailto:%40> com

> [mailto:groups (DOT) <mailto:%40> com] On

> Behalf

> > > Of Cheryl

> > > Lowrance

> > > Sent: Tuesday, June 03, 2008 1:24 PM

> > > groups (DOT) <mailto:%40> com

> > > Subject: Spect Scan / Blue Shield

> > >

> > > We'll probably be going in for a Spect Scan in a few months so

> right

> > > now, and I are trying to figure out how to make this as

> > > easy as possible as far as finances go. I've contacted my

> insurance

> > > co Motion Pic/BS and they've told me that as long as it's ordered

> by

> > > an MD and is medically necessary, it will be covered. The problem

> > > I'm running into is if Santa Imaging is a BS provider. My

> > > insurance company is saying they are out of network. Dr. Uszler

> will

> > > be covered, but SMITA will not and they will only cover 70% of the

> > > " allowed " amount. Basically, she told me it's going to cost me a

> > > lot. I can't afford it if it does. Does anyone know if SMITA is or

> > > isn't a BS provider? Anyone with BS been through it already? With

> a

> > > BS provider she said it would be covered 100%. Of course, Dr. G

> > > won't let us go anywhere else. If we can't afford it, we simply

> > > can't get it done.

> > >

> > > Cheryl

> > >

> > >

[Guest guest]

Why does Dr. U have to interpret it? Why would he need to reprocess the raw

data? Would he charge for that service, and how much?

Doesn't a spect scan provide the same data no matter the (qualified)

individual who reads it?

Does Cedars provide an interpretation when you get the scan done there? If

not, why not?

(Devil's Advocate) Kristy

From: [mailto: ] On Behalf Of Cheryl

Lowrance

Sent: Wednesday, June 04, 2008 9:27 PM

Subject: Re: [sPAM] Re: Spect Scan / Blue Shield

Thanks for the info. I've spent all day today dealing with this

issue so I could go ahead and get it pre-authorized. My insurance

company told me that it doesn't have to be pre-authorized but because

of the cost, it was highly suggested to me to do so anyway so I don't

have any surprises. The pre-authorization is good for one year so I

should be good for whenever he wants to order it since I know he

plans to order one within the next few months.

I also called Cedars to ask about their SPECTs. They told me that

any doctor can order a SPECT from them as long as they are licensed.

Since they are a provider for my insurance, it will be covered 100%,

I just need to make sure the anesthesiologist and the radiologist are

also contracted with my insurance. So I decided that I could get it

done there, have it interpreted by Dr. Uszler (he also takes our

insurance so I have a question out to them right now if I have to pay

upfront - which as someone else mentioned, is a violation of his

contract). I ran this by and she told me I needed to talk

to Dr. Uszler to see if that's acceptable to him as she didn't know

if the procedure was actually done a special way and/or if Cedars did

it the same way. When I called SMI, I was told that she didn't know

how Cedars did it but Dr. Uszler takes several pictures. I asked her

how many and she told me 4-6 so now I know to make sure they take

multiple pictures. She also called me back after speaking to Dr.

Uszler that if I go to Cedars, I should ask for the raw data on an

optical disc and he will reprocess it himself. So it looks like this

is an acceptable solution to all and now I'm just waiting to hear if

it's acceptable to Dr. G.

I've worked very hard on finding a solution that should,

theoretically, make everyone happy and get what needs to be done,

done. If this doesn't work, then I guess we get no SPECT. At least,

not ordered from Dr. G. It's unreasonable to ask anyone to pay out

of pocket for such an expensive thing when it can be covered by

insurance *somewhere*. I just don't have that kind of money lying

around I really feel that we are at a point where it's practically

essential to make the proper changes given the current state of my son.

Cheryl

On Jun 3, 2008, at 7:21 PM, PATRICIA SWEETMAN wrote:

> My boys (2 of them) got scans (2 of them) done at SMI. The first

> time was

> in 2004. At that time I was not at all prepared for the amount I

> was to pay

> after insurance (I have BC PPO, individual policy). It would have

> been nice

> to have that info before the appointment. The MRI place downstairs

> from SMI

> got all of my insurance info before hand and only asked for me to

> pay my

> portion of the bill at the appointment. In fact, if you need to go

> to SMI,

> I would insist that they price the procedure out for you and inform

> you of

> your portion of the cost - or you get in touch with your insurance

> with the

> codes that SMI is going to use on the claim.

>

> However, I was told about the up-front money for the

> anesthesiologist. As

> much as I didn't like it, I knew that I would be reimbursed for

> some of that

> cost. The problem was trying to get the in-network provider (Dr.

> Mandel is

> a contracted provider for BC) savings portion back from the

> anesthesiologist! That took almost 8 months!

>

> The second time my boys received scans at SMI, one of my sons had

> qualified

> for Medi-cal as a secondary insurance. SMI is (at least in Dec.

> 2006) a

> Medi-cal provider. The problem was that the front office did not

> submit the

> claim to Medi-cal correctly - as a secondary insurance, and made no

> effort

> to correct the situation for months. It took me months to sort out the

> problem, request SMI to resubmit, etc. I would have done it myself

> except

> that at the time I was told that only the provider can submit a

> claim. The

> claim that was submitted to BC for my other son was denied payment

> due to

> lack of prior authorization - that was a first. In the EOB that I

> received,

> it was documented that the amount submitted was NOT the

> responsibility of

> the patient as the provider was contracted provider and was bound

> to the

> contract. I tried to work with SMI providing them with BC contact

> names and

> number, Medical contact names and numbers, answers to specific

> issues/problems and what they needed to do to resolve the problem,

> etc. I

> got NO cooperation from SMI's front office/billing person. I did

> not pay

> anything to SMI until they resolved the contract issues/payments/

> coverage

> with BC.

>

> Anyway, the long and short of it is, I will NOT go back to SMI. The

> person

> in the front office is lazy and has no desire to work with you to

> resolve

> problems. If Dr. G wants my boys to have scans in the future then

> we will

> need to find a different imaging service to perform the scans. If

> you are

> to use SMI, or anyone else for that matter, I strongly encourage

> you to do

> your procedure, coverage, cost research up front. Talk with your

> insurance

> company regarding scan, scan prep, post-scan, and anesthesiology

> procedures

> and costs - providers should be able to tell you ahead of time what

> the

> procedure codes are. If the anesthesiologist is in your network,

> find out

> what the patient savings is for using an in-network provider for the

> procedure performed and subtract out any patient savings from your

> payment

> to him.

>

> I'm sorry to paint such a bleak picture on something that can

> provide Dr. G.

> with vital information on our kids, but scans are not cheap and

> like each of

> you, I don't have the spare time to do all the run around again.

>

> Patti

>

> _____

>

> From: <mailto:%40>

[mailto: <mailto:%40> ] On Behalf

> Of Robyn

> Sent: Tuesday, June 03, 2008 6:05 PM

> <mailto:%40>

> Subject: [sPAM] Re: Spect Scan / Blue Shield

>

> I thought it was Brain Matters at the UCLA Harbor Medical Center, but

> they don't take insurance either.

>

>

> > > I would not recommend Santa Imaging. Does BS give you any

> other

> > > facilities that can do the Spect? I saw Dr. Amen from the Amen

> > > Clinic give a

> > > lecture, and if my son has another spect scan, I will try to have

> > > it done

> > > there. Maybe you can get recommendations from other families?

> > >

> > > BS did cover part of my son's spect scan. What SMI failed to

> > > mention to me

> > > when I set everything up was that the anesthesiologist is a

> > > freelancer (did

> > > not find this out until AFTERWARDS) and he wanted $800 cash at

> the

> > > end of

> > > the procedure. Very, very weird.

> > >

> > > SMI did not provide any kind of interpretive report, and if I

> > > wanted copies

> > > of the images, they were another $45 each.

> > >

> > > Kristy

> > >

> > > From: groups (DOT) <mailto:%40> com

> [mailto:groups (DOT) <mailto:%40> com] On

> Behalf

> > > Of Cheryl

> > > Lowrance

> > > Sent: Tuesday, June 03, 2008 1:24 PM

> > > groups (DOT) <mailto:%40> com

> > > Subject: Spect Scan / Blue Shield

> > >

> > > We'll probably be going in for a Spect Scan in a few months so

> right

> > > now, and I are trying to figure out how to make this as

> > > easy as possible as far as finances go. I've contacted my

> insurance

> > > co Motion Pic/BS and they've told me that as long as it's ordered

> by

> > > an MD and is medically necessary, it will be covered. The problem

> > > I'm running into is if Santa Imaging is a BS provider. My

> > > insurance company is saying they are out of network. Dr. Uszler

> will

> > > be covered, but SMITA will not and they will only cover 70% of the

> > > " allowed " amount. Basically, she told me it's going to cost me a

> > > lot. I can't afford it if it does. Does anyone know if SMITA is or

> > > isn't a BS provider? Anyone with BS been through it already? With

> a

> > > BS provider she said it would be covered 100%. Of course, Dr. G

> > > won't let us go anywhere else. If we can't afford it, we simply

> > > can't get it done.

> > >

> > > Cheryl

> > >

> > >

[Guest guest]

Good questions, I'll address them the best I can below:

On Jun 4, 2008, at 10:12 PM, Kristy Nardini wrote:

> Why does Dr. U have to interpret it? Why would he need to reprocess

> the raw

> data? Would he charge for that service, and how much?

>

Cedars will not be interpreting the results the same way. When you

think about things like the " Ring of Fire " , etc. these aren't exactly

common medical interpretations. So interpretation is important. For

example, I could take my son's HHV7 and EBV labs into his ped (and i

have) and get a, " So? it just means he's been exposed. " When he says

" reprocess " I believe he means that to just have all the data put on

a disk and he'll take care of the rest, meaning don't bother printing

it out for him (I'm sure they'll print it and all that for their own

records but he doesn't need them to for him), etc. I'll have to

confirm, that, though. As for charging for the reprocessing, I'll

have to ask. That's a great question if he would charge for that on

top of the consult fee.

>

>

> Doesn't a spect scan provide the same data no matter the (qualified)

> individual who reads it?

>

Yes, would be my guess. Data is data, it's just the interpretation

that matters. I think the questionable concern was will they take as

many pictures as he would as opposed to just getting one or two. I

asked if they did something special others don't do and the office

made it sound like 4-6 pics was unusual - doesn't sound like a big

problem to overcome. Whether or not that's true, I don't know. I

plan to call Cedars after I get the okay from Dr. G to find out if

that's a problem.

>

>

> Does Cedars provide an interpretation when you get the scan done

> there? If

> not, why not?

>

I'm sure they would as that's generally part of the process of any x-

ray/scan/etc. I'm willing to bet that they will do it no matter

what. But I doubt it would be an interpretation that Dr. G would

accept.

Good stuff. You've certainly given me more to make clear.

Cheryl

>

>

> (Devil's Advocate) Kristy

>

> From: [mailto: ] On Behalf

> Of Cheryl

> Lowrance

> Sent: Wednesday, June 04, 2008 9:27 PM

>

> Subject: Re: [sPAM] Re: Spect Scan / Blue Shield

>

> Thanks for the info. I've spent all day today dealing with this

> issue so I could go ahead and get it pre-authorized. My insurance

> company told me that it doesn't have to be pre-authorized but because

> of the cost, it was highly suggested to me to do so anyway so I don't

> have any surprises. The pre-authorization is good for one year so I

> should be good for whenever he wants to order it since I know he

> plans to order one within the next few months.

>

> I also called Cedars to ask about their SPECTs. They told me that

> any doctor can order a SPECT from them as long as they are licensed.

> Since they are a provider for my insurance, it will be covered 100%,

> I just need to make sure the anesthesiologist and the radiologist are

> also contracted with my insurance. So I decided that I could get it

> done there, have it interpreted by Dr. Uszler (he also takes our

> insurance so I have a question out to them right now if I have to pay

> upfront - which as someone else mentioned, is a violation of his

> contract). I ran this by and she told me I needed to talk

> to Dr. Uszler to see if that's acceptable to him as she didn't know

> if the procedure was actually done a special way and/or if Cedars did

> it the same way. When I called SMI, I was told that she didn't know

> how Cedars did it but Dr. Uszler takes several pictures. I asked her

> how many and she told me 4-6 so now I know to make sure they take

> multiple pictures. She also called me back after speaking to Dr.

> Uszler that if I go to Cedars, I should ask for the raw data on an

> optical disc and he will reprocess it himself. So it looks like this

> is an acceptable solution to all and now I'm just waiting to hear if

> it's acceptable to Dr. G.

>

> I've worked very hard on finding a solution that should,

> theoretically, make everyone happy and get what needs to be done,

> done. If this doesn't work, then I guess we get no SPECT. At least,

> not ordered from Dr. G. It's unreasonable to ask anyone to pay out

> of pocket for such an expensive thing when it can be covered by

> insurance *somewhere*. I just don't have that kind of money lying

> around I really feel that we are at a point where it's practically

> essential to make the proper changes given the current state of my

> son.

>

> Cheryl

>

> On Jun 3, 2008, at 7:21 PM, PATRICIA SWEETMAN wrote:

>

> > My boys (2 of them) got scans (2 of them) done at SMI. The first

> > time was

> > in 2004. At that time I was not at all prepared for the amount I

> > was to pay

> > after insurance (I have BC PPO, individual policy). It would have

> > been nice

> > to have that info before the appointment. The MRI place downstairs

> > from SMI

> > got all of my insurance info before hand and only asked for me to

> > pay my

> > portion of the bill at the appointment. In fact, if you need to go

> > to SMI,

> > I would insist that they price the procedure out for you and inform

> > you of

> > your portion of the cost - or you get in touch with your insurance

> > with the

> > codes that SMI is going to use on the claim.

> >

> > However, I was told about the up-front money for the

> > anesthesiologist. As

> > much as I didn't like it, I knew that I would be reimbursed for

> > some of that

> > cost. The problem was trying to get the in-network provider (Dr.

> > Mandel is

> > a contracted provider for BC) savings portion back from the

> > anesthesiologist! That took almost 8 months!

> >

> > The second time my boys received scans at SMI, one of my sons had

> > qualified

> > for Medi-cal as a secondary insurance. SMI is (at least in Dec.

> > 2006) a

> > Medi-cal provider. The problem was that the front office did not

> > submit the

> > claim to Medi-cal correctly - as a secondary insurance, and made no

> > effort

> > to correct the situation for months. It took me months to sort

> out the

> > problem, request SMI to resubmit, etc. I would have done it myself

> > except

> > that at the time I was told that only the provider can submit a

> > claim. The

> > claim that was submitted to BC for my other son was denied payment

> > due to

> > lack of prior authorization - that was a first. In the EOB that I

> > received,

> > it was documented that the amount submitted was NOT the

> > responsibility of

> > the patient as the provider was contracted provider and was bound

> > to the

> > contract. I tried to work with SMI providing them with BC contact

> > names and

> > number, Medical contact names and numbers, answers to specific

> > issues/problems and what they needed to do to resolve the problem,

> > etc. I

> > got NO cooperation from SMI's front office/billing person. I did

> > not pay

> > anything to SMI until they resolved the contract issues/payments/

> > coverage

> > with BC.

> >

> > Anyway, the long and short of it is, I will NOT go back to SMI. The

> > person

> > in the front office is lazy and has no desire to work with you to

> > resolve

> > problems. If Dr. G wants my boys to have scans in the future then

> > we will

> > need to find a different imaging service to perform the scans. If

> > you are

> > to use SMI, or anyone else for that matter, I strongly encourage

> > you to do

> > your procedure, coverage, cost research up front. Talk with your

> > insurance

> > company regarding scan, scan prep, post-scan, and anesthesiology

> > procedures

> > and costs - providers should be able to tell you ahead of time what

> > the

> > procedure codes are. If the anesthesiologist is in your network,

> > find out

> > what the patient savings is for using an in-network provider for the

> > procedure performed and subtract out any patient savings from your

> > payment

> > to him.

> >

> > I'm sorry to paint such a bleak picture on something that can

> > provide Dr. G.

> > with vital information on our kids, but scans are not cheap and

> > like each of

> > you, I don't have the spare time to do all the run around again.

> >

> > Patti

> >

> > _____

> >

> > From: <mailto:%40>

> [mailto: <mailto:%40> ] On

> Behalf

> > Of Robyn

> > Sent: Tuesday, June 03, 2008 6:05 PM

> > <mailto:%40>

> > Subject: [sPAM] Re: Spect Scan / Blue Shield

> >

> > I thought it was Brain Matters at the UCLA Harbor Medical Center,

> but

> > they don't take insurance either.

> >

> >

> > > > I would not recommend Santa Imaging. Does BS give you any

> > other

> > > > facilities that can do the Spect? I saw Dr. Amen from the Amen

> > > > Clinic give a

> > > > lecture, and if my son has another spect scan, I will try to

> have

> > > > it done

> > > > there. Maybe you can get recommendations from other families?

> > > >

> > > > BS did cover part of my son's spect scan. What SMI failed to

> > > > mention to me

> > > > when I set everything up was that the anesthesiologist is a

> > > > freelancer (did

> > > > not find this out until AFTERWARDS) and he wanted $800 cash at

> > the

> > > > end of

> > > > the procedure. Very, very weird.

> > > >

> > > > SMI did not provide any kind of interpretive report, and if I

> > > > wanted copies

> > > > of the images, they were another $45 each.

> > > >

> > > > Kristy

> > > >

> > > > From: groups (DOT) <mailto:%40> com

> > [mailto:groups (DOT) <mailto:%40> com] On

> > Behalf

> > > > Of Cheryl

> > > > Lowrance

> > > > Sent: Tuesday, June 03, 2008 1:24 PM

> > > > groups (DOT) <mailto:%40> com

> > > > Subject: Spect Scan / Blue Shield

> > > >

> > > > We'll probably be going in for a Spect Scan in a few months so

> > right

> > > > now, and I are trying to figure out how to make

> this as

> > > > easy as possible as far as finances go. I've contacted my

> > insurance

> > > > co Motion Pic/BS and they've told me that as long as it's

> ordered

> > by

> > > > an MD and is medically necessary, it will be covered. The

> problem

> > > > I'm running into is if Santa Imaging is a BS provider. My

> > > > insurance company is saying they are out of network. Dr. Uszler

> > will

> > > > be covered, but SMITA will not and they will only cover 70%

> of the

> > > > " allowed " amount. Basically, she told me it's going to cost me a

> > > > lot. I can't afford it if it does. Does anyone know if SMITA

> is or

> > > > isn't a BS provider? Anyone with BS been through it already?

> With

> > a

> > > > BS provider she said it would be covered 100%. Of course, Dr. G

> > > > won't let us go anywhere else. If we can't afford it, we simply

> > > > can't get it done.

> > > >

> > > > Cheryl

> > > >

> > > >

[Guest guest]

Hi Cheryl,

I'm curious if you would get the same interpretation from Cedars as you

would from SMI.

I'm mostly curious because of a 'review' I saw on another clinic that does

spect scans, that basically says that every scan done there gives the same

result and that everyone gets prescribed the same types of meds ;-(

Kristy

From: [mailto: ] On Behalf Of Cheryl

Lowrance

Sent: Wednesday, June 04, 2008 11:11 PM

Subject: Re: [sPAM] Re: Spect Scan / Blue Shield

Good questions, I'll address them the best I can below:

On Jun 4, 2008, at 10:12 PM, Kristy Nardini wrote:

> Why does Dr. U have to interpret it? Why would he need to reprocess

> the raw

> data? Would he charge for that service, and how much?

>

Cedars will not be interpreting the results the same way. When you

think about things like the " Ring of Fire " , etc. these aren't exactly

common medical interpretations. So interpretation is important. For

example, I could take my son's HHV7 and EBV labs into his ped (and i

have) and get a, " So? it just means he's been exposed. " When he says

" reprocess " I believe he means that to just have all the data put on

a disk and he'll take care of the rest, meaning don't bother printing

it out for him (I'm sure they'll print it and all that for their own

records but he doesn't need them to for him), etc. I'll have to

confirm, that, though. As for charging for the reprocessing, I'll

have to ask. That's a great question if he would charge for that on

top of the consult fee.

>

>

> Doesn't a spect scan provide the same data no matter the (qualified)

> individual who reads it?

>

Yes, would be my guess. Data is data, it's just the interpretation

that matters. I think the questionable concern was will they take as

many pictures as he would as opposed to just getting one or two. I

asked if they did something special others don't do and the office

made it sound like 4-6 pics was unusual - doesn't sound like a big

problem to overcome. Whether or not that's true, I don't know. I

plan to call Cedars after I get the okay from Dr. G to find out if

that's a problem.

>

>

> Does Cedars provide an interpretation when you get the scan done

> there? If

> not, why not?

>

I'm sure they would as that's generally part of the process of any x-

ray/scan/etc. I'm willing to bet that they will do it no matter

what. But I doubt it would be an interpretation that Dr. G would

accept.

Good stuff. You've certainly given me more to make clear.

Cheryl

>

>

> (Devil's Advocate) Kristy

>

> From: <mailto:%40>

[mailto: <mailto:%40> ] On Behalf

> Of Cheryl

> Lowrance

> Sent: Wednesday, June 04, 2008 9:27 PM

> <mailto:%40>

> Subject: Re: [sPAM] Re: Spect Scan / Blue Shield

>

> Thanks for the info. I've spent all day today dealing with this

> issue so I could go ahead and get it pre-authorized. My insurance

> company told me that it doesn't have to be pre-authorized but because

> of the cost, it was highly suggested to me to do so anyway so I don't

> have any surprises. The pre-authorization is good for one year so I

> should be good for whenever he wants to order it since I know he

> plans to order one within the next few months.

>

> I also called Cedars to ask about their SPECTs. They told me that

> any doctor can order a SPECT from them as long as they are licensed.

> Since they are a provider for my insurance, it will be covered 100%,

> I just need to make sure the anesthesiologist and the radiologist are

> also contracted with my insurance. So I decided that I could get it

> done there, have it interpreted by Dr. Uszler (he also takes our

> insurance so I have a question out to them right now if I have to pay

> upfront - which as someone else mentioned, is a violation of his

> contract). I ran this by and she told me I needed to talk

> to Dr. Uszler to see if that's acceptable to him as she didn't know

> if the procedure was actually done a special way and/or if Cedars did

> it the same way. When I called SMI, I was told that she didn't know

> how Cedars did it but Dr. Uszler takes several pictures. I asked her

> how many and she told me 4-6 so now I know to make sure they take

> multiple pictures. She also called me back after speaking to Dr.

> Uszler that if I go to Cedars, I should ask for the raw data on an

> optical disc and he will reprocess it himself. So it looks like this

> is an acceptable solution to all and now I'm just waiting to hear if

> it's acceptable to Dr. G.

>

> I've worked very hard on finding a solution that should,

> theoretically, make everyone happy and get what needs to be done,

> done. If this doesn't work, then I guess we get no SPECT. At least,

> not ordered from Dr. G. It's unreasonable to ask anyone to pay out

> of pocket for such an expensive thing when it can be covered by

> insurance *somewhere*. I just don't have that kind of money lying

> around I really feel that we are at a point where it's practically

> essential to make the proper changes given the current state of my

> son.

>

> Cheryl

>

> On Jun 3, 2008, at 7:21 PM, PATRICIA SWEETMAN wrote:

>

> > My boys (2 of them) got scans (2 of them) done at SMI. The first

> > time was

> > in 2004. At that time I was not at all prepared for the amount I

> > was to pay

> > after insurance (I have BC PPO, individual policy). It would have

> > been nice

> > to have that info before the appointment. The MRI place downstairs

> > from SMI

> > got all of my insurance info before hand and only asked for me to

> > pay my

> > portion of the bill at the appointment. In fact, if you need to go

> > to SMI,

> > I would insist that they price the procedure out for you and inform

> > you of

> > your portion of the cost - or you get in touch with your insurance

> > with the

> > codes that SMI is going to use on the claim.

> >

> > However, I was told about the up-front money for the

> > anesthesiologist. As

> > much as I didn't like it, I knew that I would be reimbursed for

> > some of that

> > cost. The problem was trying to get the in-network provider (Dr.

> > Mandel is

> > a contracted provider for BC) savings portion back from the

> > anesthesiologist! That took almost 8 months!

> >

> > The second time my boys received scans at SMI, one of my sons had

> > qualified

> > for Medi-cal as a secondary insurance. SMI is (at least in Dec.

> > 2006) a

> > Medi-cal provider. The problem was that the front office did not

> > submit the

> > claim to Medi-cal correctly - as a secondary insurance, and made no

> > effort

> > to correct the situation for months. It took me months to sort

> out the

> > problem, request SMI to resubmit, etc. I would have done it myself

> > except

> > that at the time I was told that only the provider can submit a

> > claim. The

> > claim that was submitted to BC for my other son was denied payment

> > due to

> > lack of prior authorization - that was a first. In the EOB that I

> > received,

> > it was documented that the amount submitted was NOT the

> > responsibility of

> > the patient as the provider was contracted provider and was bound

> > to the

> > contract. I tried to work with SMI providing them with BC contact

> > names and

> > number, Medical contact names and numbers, answers to specific

> > issues/problems and what they needed to do to resolve the problem,

> > etc. I

> > got NO cooperation from SMI's front office/billing person. I did

> > not pay

> > anything to SMI until they resolved the contract issues/payments/

> > coverage

> > with BC.

> >

> > Anyway, the long and short of it is, I will NOT go back to SMI. The

> > person

> > in the front office is lazy and has no desire to work with you to

> > resolve

> > problems. If Dr. G wants my boys to have scans in the future then

> > we will

> > need to find a different imaging service to perform the scans. If

> > you are

> > to use SMI, or anyone else for that matter, I strongly encourage

> > you to do

> > your procedure, coverage, cost research up front. Talk with your

> > insurance

> > company regarding scan, scan prep, post-scan, and anesthesiology

> > procedures

> > and costs - providers should be able to tell you ahead of time what

> > the

> > procedure codes are. If the anesthesiologist is in your network,

> > find out

> > what the patient savings is for using an in-network provider for the

> > procedure performed and subtract out any patient savings from your

> > payment

> > to him.

> >

> > I'm sorry to paint such a bleak picture on something that can

> > provide Dr. G.

> > with vital information on our kids, but scans are not cheap and

> > like each of

> > you, I don't have the spare time to do all the run around again.

> >

> > Patti

> >

> > _____

> >

> > From: <mailto:%40>

<mailto:%40>

> [mailto: <mailto:%40>

<mailto:%40> ] On

> Behalf

> > Of Robyn

> > Sent: Tuesday, June 03, 2008 6:05 PM

> > <mailto:%40>

<mailto:%40>

> > Subject: [sPAM] Re: Spect Scan / Blue Shield

> >

> > I thought it was Brain Matters at the UCLA Harbor Medical Center,

> but

> > they don't take insurance either.

> >

> >

> > > > I would not recommend Santa Imaging. Does BS give you any

> > other

> > > > facilities that can do the Spect? I saw Dr. Amen from the Amen

> > > > Clinic give a

> > > > lecture, and if my son has another spect scan, I will try to

> have

> > > > it done

> > > > there. Maybe you can get recommendations from other families?

> > > >

> > > > BS did cover part of my son's spect scan. What SMI failed to

> > > > mention to me

> > > > when I set everything up was that the anesthesiologist is a

> > > > freelancer (did

> > > > not find this out until AFTERWARDS) and he wanted $800 cash at

> > the

> > > > end of

> > > > the procedure. Very, very weird.

> > > >

> > > > SMI did not provide any kind of interpretive report, and if I

> > > > wanted copies

> > > > of the images, they were another $45 each.

> > > >

> > > > Kristy

> > > >

> > > > From: groups (DOT) <mailto:%40> com

> > [mailto:groups (DOT) <mailto:%40> com] On

> > Behalf

> > > > Of Cheryl

> > > > Lowrance

> > > > Sent: Tuesday, June 03, 2008 1:24 PM

> > > > groups (DOT) <mailto:%40> com

> > > > Subject: Spect Scan / Blue Shield

> > > >

> > > > We'll probably be going in for a Spect Scan in a few months so

> > right

> > > > now, and I are trying to figure out how to make

> this as

> > > > easy as possible as far as finances go. I've contacted my

> > insurance

> > > > co Motion Pic/BS and they've told me that as long as it's

> ordered

> > by

> > > > an MD and is medically necessary, it will be covered. The

> problem

> > > > I'm running into is if Santa Imaging is a BS provider. My

> > > > insurance company is saying they are out of network. Dr. Uszler

> > will

> > > > be covered, but SMITA will not and they will only cover 70%

> of the

> > > > " allowed " amount. Basically, she told me it's going to cost me a

> > > > lot. I can't afford it if it does. Does anyone know if SMITA

> is or

> > > > isn't a BS provider? Anyone with BS been through it already?

> With

> > a

> > > > BS provider she said it would be covered 100%. Of course, Dr. G

> > > > won't let us go anywhere else. If we can't afford it, we simply

> > > > can't get it done.

> > > >

> > > > Cheryl

> > > >

> > > >

[Guest guest]

Hi, Cheryl.

I sure wish I'd had more time before Noah's spect scan. Dr. G ordered it at

our first visit and wanted it done right away before our follow up in three

weeks. I would do so much differently.

One word of caution regarding Cedars: we had EEGs done there and they sent

them to be read by a doctor outside of Cedars. Consequently, I kept receiving

bills from this guy for six months after the procedure. The only reason I'm

telling you this is that if Cedars sends it out to be read and you file a claim

for Dr. Uszler's reading, they may not pay for both of them. You may want to

have them write on the paperwork somewhere that you have your own expert

consulting and you just need the raw data sent to him.

Good luck and please let us know how it turns out.

All the best,

Robyn

Kristy Nardini <krnardini@...> wrote:

Hi Cheryl,

I'm curious if you would get the same interpretation from Cedars as you

would from SMI.

I'm mostly curious because of a 'review' I saw on another clinic that does

spect scans, that basically says that every scan done there gives the same

result and that everyone gets prescribed the same types of meds ;-(

Kristy

From: [mailto: ] On Behalf Of Cheryl

Lowrance

Sent: Wednesday, June 04, 2008 11:11 PM

Subject: Re: [sPAM] Re: Spect Scan / Blue Shield

Good questions, I'll address them the best I can below:

On Jun 4, 2008, at 10:12 PM, Kristy Nardini wrote:

> Why does Dr. U have to interpret it? Why would he need to reprocess

> the raw

> data? Would he charge for that service, and how much?

>

Cedars will not be interpreting the results the same way. When you

think about things like the " Ring of Fire " , etc. these aren't exactly

common medical interpretations. So interpretation is important. For

example, I could take my son's HHV7 and EBV labs into his ped (and i

have) and get a, " So? it just means he's been exposed. " When he says

" reprocess " I believe he means that to just have all the data put on

a disk and he'll take care of the rest, meaning don't bother printing

it out for him (I'm sure they'll print it and all that for their own

records but he doesn't need them to for him), etc. I'll have to

confirm, that, though. As for charging for the reprocessing, I'll

have to ask. That's a great question if he would charge for that on

top of the consult fee.

>

>

> Doesn't a spect scan provide the same data no matter the (qualified)

> individual who reads it?

>

Yes, would be my guess. Data is data, it's just the interpretation

that matters. I think the questionable concern was will they take as

many pictures as he would as opposed to just getting one or two. I

asked if they did something special others don't do and the office

made it sound like 4-6 pics was unusual - doesn't sound like a big

problem to overcome. Whether or not that's true, I don't know. I

plan to call Cedars after I get the okay from Dr. G to find out if

that's a problem.

>

>

> Does Cedars provide an interpretation when you get the scan done

> there? If

> not, why not?

>

I'm sure they would as that's generally part of the process of any x-

ray/scan/etc. I'm willing to bet that they will do it no matter

what. But I doubt it would be an interpretation that Dr. G would

accept.

Good stuff. You've certainly given me more to make clear.

Cheryl

>

>

> (Devil's Advocate) Kristy

>

> From: <mailto:%40>

[mailto: <mailto:%40> ] On Behalf

> Of Cheryl

> Lowrance

> Sent: Wednesday, June 04, 2008 9:27 PM

> <mailto:%40>

> Subject: Re: [sPAM] Re: Spect Scan / Blue Shield

>

> Thanks for the info. I've spent all day today dealing with this

> issue so I could go ahead and get it pre-authorized. My insurance

> company told me that it doesn't have to be pre-authorized but because

> of the cost, it was highly suggested to me to do so anyway so I don't

> have any surprises. The pre-authorization is good for one year so I

> should be good for whenever he wants to order it since I know he

> plans to order one within the next few months.

>

> I also called Cedars to ask about their SPECTs. They told me that

> any doctor can order a SPECT from them as long as they are licensed.

> Since they are a provider for my insurance, it will be covered 100%,

> I just need to make sure the anesthesiologist and the radiologist are

> also contracted with my insurance. So I decided that I could get it

> done there, have it interpreted by Dr. Uszler (he also takes our

> insurance so I have a question out to them right now if I have to pay

> upfront - which as someone else mentioned, is a violation of his

> contract). I ran this by and she told me I needed to talk

> to Dr. Uszler to see if that's acceptable to him as she didn't know

> if the procedure was actually done a special way and/or if Cedars did

> it the same way. When I called SMI, I was told that she didn't know

> how Cedars did it but Dr. Uszler takes several pictures. I asked her

> how many and she told me 4-6 so now I know to make sure they take

> multiple pictures. She also called me back after speaking to Dr.

> Uszler that if I go to Cedars, I should ask for the raw data on an

> optical disc and he will reprocess it himself. So it looks like this

> is an acceptable solution to all and now I'm just waiting to hear if

> it's acceptable to Dr. G.

>

> I've worked very hard on finding a solution that should,

> theoretically, make everyone happy and get what needs to be done,

> done. If this doesn't work, then I guess we get no SPECT. At least,

> not ordered from Dr. G. It's unreasonable to ask anyone to pay out

> of pocket for such an expensive thing when it can be covered by

> insurance *somewhere*. I just don't have that kind of money lying

> around I really feel that we are at a point where it's practically

> essential to make the proper changes given the current state of my

> son.

>

> Cheryl

>

> On Jun 3, 2008, at 7:21 PM, PATRICIA SWEETMAN wrote:

>

> > My boys (2 of them) got scans (2 of them) done at SMI. The first

> > time was

> > in 2004. At that time I was not at all prepared for the amount I

> > was to pay

> > after insurance (I have BC PPO, individual policy). It would have

> > been nice

> > to have that info before the appointment. The MRI place downstairs

> > from SMI

> > got all of my insurance info before hand and only asked for me to

> > pay my

> > portion of the bill at the appointment. In fact, if you need to go

> > to SMI,

> > I would insist that they price the procedure out for you and inform

> > you of

> > your portion of the cost - or you get in touch with your insurance

> > with the

> > codes that SMI is going to use on the claim.

> >

> > However, I was told about the up-front money for the

> > anesthesiologist. As

> > much as I didn't like it, I knew that I would be reimbursed for

> > some of that

> > cost. The problem was trying to get the in-network provider (Dr.

> > Mandel is

> > a contracted provider for BC) savings portion back from the

> > anesthesiologist! That took almost 8 months!

> >

> > The second time my boys received scans at SMI, one of my sons had

> > qualified

> > for Medi-cal as a secondary insurance. SMI is (at least in Dec.

> > 2006) a

> > Medi-cal provider. The problem was that the front office did not

> > submit the

> > claim to Medi-cal correctly - as a secondary insurance, and made no

> > effort

> > to correct the situation for months. It took me months to sort

> out the

> > problem, request SMI to resubmit, etc. I would have done it myself

> > except

> > that at the time I was told that only the provider can submit a

> > claim. The

> > claim that was submitted to BC for my other son was denied payment

> > due to

> > lack of prior authorization - that was a first. In the EOB that I

> > received,

> > it was documented that the amount submitted was NOT the

> > responsibility of

> > the patient as the provider was contracted provider and was bound

> > to the

> > contract. I tried to work with SMI providing them with BC contact

> > names and

> > number, Medical contact names and numbers, answers to specific

> > issues/problems and what they needed to do to resolve the problem,

> > etc. I

> > got NO cooperation from SMI's front office/billing person. I did

> > not pay

> > anything to SMI until they resolved the contract issues/payments/

> > coverage

> > with BC.

> >

> > Anyway, the long and short of it is, I will NOT go back to SMI. The

> > person

> > in the front office is lazy and has no desire to work with you to

> > resolve

> > problems. If Dr. G wants my boys to have scans in the future then

> > we will

> > need to find a different imaging service to perform the scans. If

> > you are

> > to use SMI, or anyone else for that matter, I strongly encourage

> > you to do

> > your procedure, coverage, cost research up front. Talk with your

> > insurance

> > company regarding scan, scan prep, post-scan, and anesthesiology

> > procedures

> > and costs - providers should be able to tell you ahead of time what

> > the

> > procedure codes are. If the anesthesiologist is in your network,

> > find out

> > what the patient savings is for using an in-network provider for the

> > procedure performed and subtract out any patient savings from your

> > payment

> > to him.

> >

> > I'm sorry to paint such a bleak picture on something that can

> > provide Dr. G.

> > with vital information on our kids, but scans are not cheap and

> > like each of

> > you, I don't have the spare time to do all the run around again.

> >

> > Patti

> >

> > _____

> >

> > From: <mailto:%40>

<mailto:%40>

> [mailto: <mailto:%40>

<mailto:%40> ] On

> Behalf

> > Of Robyn

> > Sent: Tuesday, June 03, 2008 6:05 PM

> > <mailto:%40>

<mailto:%40>

> > Subject: [sPAM] Re: Spect Scan / Blue Shield

> >

> > I thought it was Brain Matters at the UCLA Harbor Medical Center,

> but

> > they don't take insurance either.

> >

> >

> > > > I would not recommend Santa Imaging. Does BS give you any

> > other

> > > > facilities that can do the Spect? I saw Dr. Amen from the Amen

> > > > Clinic give a

> > > > lecture, and if my son has another spect scan, I will try to

> have

> > > > it done

> > > > there. Maybe you can get recommendations from other families?

> > > >

> > > > BS did cover part of my son's spect scan. What SMI failed to

> > > > mention to me

> > > > when I set everything up was that the anesthesiologist is a

> > > > freelancer (did

> > > > not find this out until AFTERWARDS) and he wanted $800 cash at

> > the

> > > > end of

> > > > the procedure. Very, very weird.

> > > >

> > > > SMI did not provide any kind of interpretive report, and if I

> > > > wanted copies

> > > > of the images, they were another $45 each.

> > > >

> > > > Kristy

> > > >

> > > > From: groups (DOT) <mailto:%40> com

> > [mailto:groups (DOT) <mailto:%40> com] On

> > Behalf

> > > > Of Cheryl

> > > > Lowrance

> > > > Sent: Tuesday, June 03, 2008 1:24 PM

> > > > groups (DOT) <mailto:%40> com

> > > > Subject: Spect Scan / Blue Shield

> > > >

> > > > We'll probably be going in for a Spect Scan in a few months so

> > right

> > > > now, and I are trying to figure out how to make

> this as

> > > > easy as possible as far as finances go. I've contacted my

> > insurance

> > > > co Motion Pic/BS and they've told me that as long as it's

> ordered

> > by

> > > > an MD and is medically necessary, it will be covered. The

> problem

> > > > I'm running into is if Santa Imaging is a BS provider. My

> > > > insurance company is saying they are out of network. Dr. Uszler

> > will

> > > > be covered, but SMITA will not and they will only cover 70%

> of the

> > > > " allowed " amount. Basically, she told me it's going to cost me a

> > > > lot. I can't afford it if it does. Does anyone know if SMITA

> is or

> > > > isn't a BS provider? Anyone with BS been through it already?

> With

> > a

> > > > BS provider she said it would be covered 100%. Of course, Dr. G

> > > > won't let us go anywhere else. If we can't afford it, we simply

> > > > can't get it done.

> > > >

> > > > Cheryl

> > > >

> > > >

[Guest guest]

most of the time b/s shield will allow for a second opinion. I had all of my

three daughters spect scans re read on a second opinion.

The raw data is the gray scale spect scans, which Dr U will read, rather than

the color ones, I simply had the raw data and the color scale plus the reading

from the other spect scan place and took them to Dr U.

The reason for the reading with Dr U, is because he has the experience to read

spect scans in light of comparison prior and after treatments. Such as the use

of HBOT post and prior.

In the last several years I have seen that spect scans after treatment are

treated as a mistake if they show improvements, because it just does not happen

( so the first place told me) in their words. " Oh the child must have moved,

SPECT scans do not improve!, " So I did not argue.

I was so thrilled because I knew that all the spect scan were now normal. it was

worth the time and money involved, the treatment had worked.

Spect Scan / Blue Shield

> > > >

> > > > We'll probably be going in for a Spect Scan in a few months so

> > right

> > > > now, and I are trying to figure out how to make

> this as

> > > > easy as possible as far as finances go. I've contacted my

> > insurance

> > > > co Motion Pic/BS and they've told me that as long as it's

> ordered

> > by

> > > > an MD and is medically necessary, it will be covered. The

> problem

> > > > I'm running into is if Santa Imaging is a BS provider. My

> > > > insurance company is saying they are out of network. Dr. Uszler

> > will

> > > > be covered, but SMITA will not and they will only cover 70%

> of the

> > > > " allowed " amount. Basically, she told me it's going to cost me a

> > > > lot. I can't afford it if it does. Does anyone know if SMITA

> is or

> > > > isn't a BS provider? Anyone with BS been through it already?

> With

> > a

> > > > BS provider she said it would be covered 100%. Of course, Dr. G

> > > > won't let us go anywhere else. If we can't afford it, we simply

> > > > can't get it done.

> > > >

> > > > Cheryl

> > > >

> > > >

[Guest guest]

I never gave the second opinion a thought. That's excellent advice! I'm thrilled

to hear that the treatment worked so well. I have two of my boys on the

protocol: one mild/mod ASD, cyclical vomiting syndrome and seizures; and one

Aspie, seizure disorder and food allergies. We haven't had a spect on my oldest

as Dr. G thought he was classic . My younger ASD son, however, had a very

confusing and perplexing medical history and Dr. G felt he needed as much info

as possible before we proceeded with anything. I'm glad we did it before

starting the protocol, so when we repeat the scan, we'll have something to

compare it to. I just wish I had done things differently, so we could be

reimbursed by the insurance company (also BCBS Federal). We're still trying!

Take care and thanks for the input.

Robyn

SUSAN RODRIGUEZ <hyperbaric1@...> wrote:

most of the time b/s shield will allow for a second opinion. I had all

of my three daughters spect scans re read on a second opinion.

The raw data is the gray scale spect scans, which Dr U will read, rather than

the color ones, I simply had the raw data and the color scale plus the reading

from the other spect scan place and took them to Dr U.

The reason for the reading with Dr U, is because he has the experience to read

spect scans in light of comparison prior and after treatments. Such as the use

of HBOT post and prior.

In the last several years I have seen that spect scans after treatment are

treated as a mistake if they show improvements, because it just does not happen

( so the first place told me) in their words. " Oh the child must have moved,

SPECT scans do not improve!, " So I did not argue.

I was so thrilled because I knew that all the spect scan were now normal. it was

worth the time and money involved, the treatment had worked.

Spect Scan / Blue Shield

> > > >

> > > > We'll probably be going in for a Spect Scan in a few months so

> > right

> > > > now, and I are trying to figure out how to make

> this as

> > > > easy as possible as far as finances go. I've contacted my

> > insurance

> > > > co Motion Pic/BS and they've told me that as long as it's

> ordered

> > by

> > > > an MD and is medically necessary, it will be covered. The

> problem

> > > > I'm running into is if Santa Imaging is a BS provider. My

> > > > insurance company is saying they are out of network. Dr. Uszler

> > will

> > > > be covered, but SMITA will not and they will only cover 70%

> of the

> > > > " allowed " amount. Basically, she told me it's going to cost me a

> > > > lot. I can't afford it if it does. Does anyone know if SMITA

> is or

> > > > isn't a BS provider? Anyone with BS been through it already?

> With

> > a

> > > > BS provider she said it would be covered 100%. Of course, Dr. G

> > > > won't let us go anywhere else. If we can't afford it, we simply

> > > > can't get it done.

> > > >

> > > > Cheryl

> > > >

> > > >

[Guest guest]

I think *maybe* I remember hearing that in order to compare ³apples to

apples², the SPECT machine needed to be calibrated the same way each time.

Or maybe I dreamt it. It¹s just one of those foggy memories I have from way

back.

It would be good to know, though, if a scan done at one place would be

useable as a comparison to one done at another time at another location.

Caroline

From: Kristy Nardini <krnardini@...>

Reply-< >

Date: Wed, 04 Jun 2008 22:12:42 -0700

< >

Subject: RE: [sPAM] Re: Spect Scan / Blue Shield

Why does Dr. U have to interpret it? Why would he need to reprocess the raw

data? Would he charge for that service, and how much?

Doesn't a spect scan provide the same data no matter the (qualified)

individual who reads it?

Does Cedars provide an interpretation when you get the scan done there? If

not, why not?

(Devil's Advocate) Kristy