RE: [SPAM]Re: [SPAM] insurance issues

[Guest guest]

Thanks, for such a detailed response! I really appreciate it.

Patti Sweetman

909.374.9121

_____

From: [mailto: ] On Behalf Of

Sent: Monday, September 22, 2008 6:23 PM

Subject: [sPAM]Re: [sPAM] insurance issues

Hi Pattie-

Usually the only way to get Anthem to cover someone as an in-network

provider is to request a " single case agreement " (may not be called that

exactly), or to ask for a " gap request " - usually for when you can't get an

in-network provider in your location (not as common). For a single case

agreement, the doctor usually gets a fax requesting that they accept the

in-network payment and write off the rest. Dr G isn't usually going to do

that - they often request to reduce a bill by almost half, and they will

discount it down to approximately $45-$65 - ok if you're talking about a

5-10 minute office visit, but not for higher level office visits.

Another option is a letter trying to make a persuasive case that your child

has immune dysfunction resulting in cognitive dysfunction - see the

pediatric definition of CFS by googling - and that very few physicians have

any expertise in Chronic Fatigue Syndome or Immune Dysfunction, and that Dr

Goldberg specializes in it as a pediatrician.

It's hard to get this accomplished. It works better if you have impressive

enough findings of immune issues in labs - not common to . If there is

a history of chronic infections, that could help. Any medical history you'd

like to share with me, I can let you know if there is anything that could

stand out.

HTH-

[sPAM] insurance issues

Has anyone had success in getting their insurance to cover Dr. G as

an " in-network provider " ? We have Anthem Blue Cross.

Thank you,