Re: Fighing Insurance, etc

[Guest guest]

Michele--out of curiosity (we are seeing Dr Herzenberg too), if you

are already seeing Dr Herzenberg, why do you want to go see Dr

Ponseti? Has Dr Herzenberg suggested it? Is there a complication that

you feel only Dr Ponseti could direct you about?

Helen

> Hi, I saw the post on fighing insurance companies for

approval,etc.

> I was on the phone all day with ours trying to get approval to go

for

> a second opinion w/Dr. Ponseti. He accepts Aetna which is our

> insurance but since it is so far away (him in Iowa us in NJ) they

say

> it is a different Aetna network. They say we can use our Insurance

> out of Network, by paying 1000 deductible then they will cover 30%

of

> treatment after that leaving us with the remaing 70%. I told them

> that we really just need one visit, that after that we would just

> have Dr. Ponseti coloberate w/ Dr. Herzenberg and we would remain

> with him, etc. that we really are just asking for a 1 time in

person

> visit. They said what we need to do to fight them is Go to

Collin's

> peditrician (who doesn't even deal w/clubfoot...doesn't make

sense),

> have her call the Insurance company and tell them that she feels it

> is of medical neccessaity that we see Dr. Ponseti and that there is

> no one else around here qualified the same, etc. Then she has to

put

> it in writing, they then will investigate it themselves and see if

> they believe what the peditrician is saying. If they find it to be

> true then maybe they will allow us an exception and consider it in-

> network. I explained to the insurance company that we are seeing

Dr.

> Herzenberg who is out of network for us but they allowed him to be

in

> network because no other doctors do the ponseti method around here,

> etc. so I feel that we already proved there are no qualifed doctors

> around here or we wouldn't have gotten approval to have Dr. H,

> etc...but she said we still have to go by the books and start all

> over again, etc.... I heard that if you just go to Dr. Ponseti w/

no

> insurance it is like 300.00 for the visit and 160.00 for x-rays, it

> seems like that is easier to do then pay 1000 out of network

> deductible for us if we don't get it approved. I have to now get a

> hold of the peditrician and talk to her next to see what shes

willing

> to do for us now before we can go any further. If I were

financially

> stable I think I would just take the angel flighs out ther stay in

> the ronald mcdonald house and just pay the 300 out of pocket so I

> didn't have to be on the phone all day fighting, but were not right

> now so I'm going to try to battle this week and next week and see

> where it gets me before trying to come up with the extra money.

But

> to give hope to others we did win the battle to see Dr. Herzenberg

> and he is great, so I know it is possible to win again. Good Luck

to

> all of those trying to get approval and fighting these beaucratic

> insurance companies who just care about the money, etc.... I think

> sometimes just hang up leand call right back and you'll get someone

> else that might care enought to help you then the person you spoke

> with 5 minutes before, It's frustrating but being persistant seems

to

> get your further.

>

> MIchele

[Guest guest]

Michele--out of curiosity (we are seeing Dr Herzenberg too), if you

are already seeing Dr Herzenberg, why do you want to go see Dr

Ponseti? Has Dr Herzenberg suggested it? Is there a complication that

you feel only Dr Ponseti could direct you about?

Helen

> Hi, I saw the post on fighing insurance companies for

approval,etc.

> I was on the phone all day with ours trying to get approval to go

for

> a second opinion w/Dr. Ponseti. He accepts Aetna which is our

> insurance but since it is so far away (him in Iowa us in NJ) they

say

> it is a different Aetna network. They say we can use our Insurance

> out of Network, by paying 1000 deductible then they will cover 30%

of

> treatment after that leaving us with the remaing 70%. I told them

> that we really just need one visit, that after that we would just

> have Dr. Ponseti coloberate w/ Dr. Herzenberg and we would remain

> with him, etc. that we really are just asking for a 1 time in

person

> visit. They said what we need to do to fight them is Go to

Collin's

> peditrician (who doesn't even deal w/clubfoot...doesn't make

sense),

> have her call the Insurance company and tell them that she feels it

> is of medical neccessaity that we see Dr. Ponseti and that there is

> no one else around here qualified the same, etc. Then she has to

put

> it in writing, they then will investigate it themselves and see if

> they believe what the peditrician is saying. If they find it to be

> true then maybe they will allow us an exception and consider it in-

> network. I explained to the insurance company that we are seeing

Dr.

> Herzenberg who is out of network for us but they allowed him to be

in

> network because no other doctors do the ponseti method around here,

> etc. so I feel that we already proved there are no qualifed doctors

> around here or we wouldn't have gotten approval to have Dr. H,

> etc...but she said we still have to go by the books and start all

> over again, etc.... I heard that if you just go to Dr. Ponseti w/

no

> insurance it is like 300.00 for the visit and 160.00 for x-rays, it

> seems like that is easier to do then pay 1000 out of network

> deductible for us if we don't get it approved. I have to now get a

> hold of the peditrician and talk to her next to see what shes

willing

> to do for us now before we can go any further. If I were

financially

> stable I think I would just take the angel flighs out ther stay in

> the ronald mcdonald house and just pay the 300 out of pocket so I

> didn't have to be on the phone all day fighting, but were not right

> now so I'm going to try to battle this week and next week and see

> where it gets me before trying to come up with the extra money.

But

> to give hope to others we did win the battle to see Dr. Herzenberg

> and he is great, so I know it is possible to win again. Good Luck

to

> all of those trying to get approval and fighting these beaucratic

> insurance companies who just care about the money, etc.... I think

> sometimes just hang up leand call right back and you'll get someone

> else that might care enought to help you then the person you spoke

> with 5 minutes before, It's frustrating but being persistant seems

to

> get your further.

>

> MIchele

[Guest guest]

Hi Helen, We love Dr. Herzenberg...we just need a second opinion

mostly for peace of mind. I'm sure Dr. H is right and Collin needs

the taylor spatial frame (its an external fixator that is surgically

put in then surgically removed again). I just think I should go for

another great doctors opinoin so I feel better... I know it sounds

selfish, but I really have to do it I think or I just won't sleep at

night. I'm working on it, hopefully it will work out.

Michele

[Guest guest]

Hi Helen, We love Dr. Herzenberg...we just need a second opinion

mostly for peace of mind. I'm sure Dr. H is right and Collin needs

the taylor spatial frame (its an external fixator that is surgically

put in then surgically removed again). I just think I should go for

another great doctors opinoin so I feel better... I know it sounds

selfish, but I really have to do it I think or I just won't sleep at

night. I'm working on it, hopefully it will work out.

Michele

[Guest guest]

,

Just think... your peace of mind brings you to meet Dr. Ponseti in

person! I so envy you! I don't wish Darbi had issues, no way. But if

there were some reason I thought I could make a case for going to see

him... I sure would! I will never get to meet him and that saddens

me. So who cares if anyone thinks it's selfish? It is and it isn't! What

if... Dr. P says something different when he sees Colin's foot? What

IF??? You'll never know unless you go see him. You will likely think

forever you may have had some other option and worry that you didn't do

enough. Just nick all that in the bud right now, meet the man (and please

tell him we love him - thank him if you would for me) and find out for

sure. Then relax and know you did everything possible. It's all

good. I'm glad you're going.

Kori

At 05:46 PM 6/29/2005, you wrote:

>Hi Helen, We love Dr. Herzenberg...we just need a second opinion

>mostly for peace of mind. I'm sure Dr. H is right and Collin needs

>the taylor spatial frame (its an external fixator that is surgically

>put in then surgically removed again). I just think I should go for

>another great doctors opinoin so I feel better... I know it sounds

>selfish, but I really have to do it I think or I just won't sleep at

>night. I'm working on it, hopefully it will work out.

>

>Michele

>

>

>

>

>

[Guest guest]

,

Just think... your peace of mind brings you to meet Dr. Ponseti in

person! I so envy you! I don't wish Darbi had issues, no way. But if

there were some reason I thought I could make a case for going to see

him... I sure would! I will never get to meet him and that saddens

me. So who cares if anyone thinks it's selfish? It is and it isn't! What

if... Dr. P says something different when he sees Colin's foot? What

IF??? You'll never know unless you go see him. You will likely think

forever you may have had some other option and worry that you didn't do

enough. Just nick all that in the bud right now, meet the man (and please

tell him we love him - thank him if you would for me) and find out for

sure. Then relax and know you did everything possible. It's all

good. I'm glad you're going.

Kori

At 05:46 PM 6/29/2005, you wrote:

>Hi Helen, We love Dr. Herzenberg...we just need a second opinion

>mostly for peace of mind. I'm sure Dr. H is right and Collin needs

>the taylor spatial frame (its an external fixator that is surgically

>put in then surgically removed again). I just think I should go for

>another great doctors opinoin so I feel better... I know it sounds

>selfish, but I really have to do it I think or I just won't sleep at

>night. I'm working on it, hopefully it will work out.

>

>Michele

>

>

>

>

>

[Guest guest]

,

I'm glad you are going too. It's what I would do.

I can't help with insurance issues, but about flying in.. we've

found, over the course of many trips, that, when flying in from the

east coast, it works best for us to come the day before the

appointment. There are noontime flights that get you in to Cedar

Rapids in the late afternoon. You have the rest of the evening to

eat, rest up, get situated, then get up early to go to the hospital,

and leave straight from there to an afternoon flight home.

I hope you are able to work out the insurance and flight

arrangements.. I, too, would want that opinion from the doctors in

Iowa.. it would help you feel certain about the course you take.. and

Dr. Ponseti might even recommend something else. Then, of course,

you'd have another decision to make. I can recall at least one other

mom who had conflicting opinions from her local, very experienced

Ponseti method doctor and Dr. Ponseti on what to do about a relapse,

so it has happened..

Please know that we're thinking of you and pulling for Collin and

wishing you both the very best.

Take care,

and Claire

6/20/00

> ,

>

> Just think... your peace of mind brings you to meet Dr. Ponseti in

> person! I so envy you! I don't wish Darbi had issues, no way.

But if

> there were some reason I thought I could make a case for going to

see

> him... I sure would! I will never get to meet him and that

saddens

> me. So who cares if anyone thinks it's selfish? It is and it

isn't! What

> if... Dr. P says something different when he sees Colin's foot?

What

> IF??? You'll never know unless you go see him. You will likely

think

> forever you may have had some other option and worry that you

didn't do

> enough. Just nick all that in the bud right now, meet the man (and

please

> tell him we love him - thank him if you would for me) and find out

for

> sure. Then relax and know you did everything possible. It's all

> good. I'm glad you're going.

>

> Kori

[Guest guest]

,

I'm glad you are going too. It's what I would do.

I can't help with insurance issues, but about flying in.. we've

found, over the course of many trips, that, when flying in from the

east coast, it works best for us to come the day before the

appointment. There are noontime flights that get you in to Cedar

Rapids in the late afternoon. You have the rest of the evening to

eat, rest up, get situated, then get up early to go to the hospital,

and leave straight from there to an afternoon flight home.

I hope you are able to work out the insurance and flight

arrangements.. I, too, would want that opinion from the doctors in

Iowa.. it would help you feel certain about the course you take.. and

Dr. Ponseti might even recommend something else. Then, of course,

you'd have another decision to make. I can recall at least one other

mom who had conflicting opinions from her local, very experienced

Ponseti method doctor and Dr. Ponseti on what to do about a relapse,

so it has happened..

Please know that we're thinking of you and pulling for Collin and

wishing you both the very best.

Take care,

and Claire

6/20/00

> ,

>

> Just think... your peace of mind brings you to meet Dr. Ponseti in

> person! I so envy you! I don't wish Darbi had issues, no way.

But if

> there were some reason I thought I could make a case for going to

see

> him... I sure would! I will never get to meet him and that

saddens

> me. So who cares if anyone thinks it's selfish? It is and it

isn't! What

> if... Dr. P says something different when he sees Colin's foot?

What

> IF??? You'll never know unless you go see him. You will likely

think

> forever you may have had some other option and worry that you

didn't do

> enough. Just nick all that in the bud right now, meet the man (and

please

> tell him we love him - thank him if you would for me) and find out

for

> sure. Then relax and know you did everything possible. It's all

> good. I'm glad you're going.

>

> Kori

[Guest guest]

It may be easier to just pay the bill from Ponseti. We went and our bill was

like 200.00 for a consultation. I just paid the bill. Was a lot easier than

dealing with the insurance. And they will work with you.

-------------- Original message --------------

Hi, I saw the post on fighing insurance companies for approval,etc.

I was on the phone all day with ours trying to get approval to go for

a second opinion w/Dr. Ponseti. He accepts Aetna which is our

insurance but since it is so far away (him in Iowa us in NJ) they say

it is a different Aetna network. They say we can use our Insurance

out of Network, by paying 1000 deductible then they will cover 30% of

treatment after that leaving us with the remaing 70%. I told them

that we really just need one visit, that after that we would just

have Dr. Ponseti coloberate w/ Dr. Herzenberg and we would remain

with him, etc. that we really are just asking for a 1 time in person

visit. They said what we need to do to fight them is Go to Collin's

peditrician (who doesn't even deal w/clubfoot...doesn't make sense),

have her call the Insurance company and tell them that she feels it

is of medical neccessaity that we see Dr. Ponseti and that there is

no one else around here qualified the same, etc. Then she has to put

it in writing, they then will investigate it themselves and see if

they believe what the peditrician is saying. If they find it to be

true then maybe they will allow us an exception and consider it in-

network. I explained to the insurance company that we are seeing Dr.

Herzenberg who is out of network for us but they allowed him to be in

network because no other doctors do the ponseti method around here,

etc. so I feel that we already proved there are no qualifed doctors

around here or we wouldn't have gotten approval to have Dr. H,

etc...but she said we still have to go by the books and start all

over again, etc.... I heard that if you just go to Dr. Ponseti w/ no

insurance it is like 300.00 for the visit and 160.00 for x-rays, it

seems like that is easier to do then pay 1000 out of network

deductible for us if we don't get it approved. I have to now get a

hold of the peditrician and talk to her next to see what shes willing

to do for us now before we can go any further. If I were financially

stable I think I would just take the angel flighs out ther stay in

the ronald mcdonald house and just pay the 300 out of pocket so I

didn't have to be on the phone all day fighting, but were not right

now so I'm going to try to battle this week and next week and see

where it gets me before trying to come up with the extra money. But

to give hope to others we did win the battle to see Dr. Herzenberg

and he is great, so I know it is possible to win again. Good Luck to

all of those trying to get approval and fighting these beaucratic

insurance companies who just care about the money, etc.... I think

sometimes just hang up leand call right back and you'll get someone

else that might care enought to help you then the person you spoke

with 5 minutes before, It's frustrating but being persistant seems to

get your further.

MIchele

[Guest guest]

It may be easier to just pay the bill from Ponseti. We went and our bill was

like 200.00 for a consultation. I just paid the bill. Was a lot easier than

dealing with the insurance. And they will work with you.

-------------- Original message --------------

Hi, I saw the post on fighing insurance companies for approval,etc.

I was on the phone all day with ours trying to get approval to go for

a second opinion w/Dr. Ponseti. He accepts Aetna which is our

insurance but since it is so far away (him in Iowa us in NJ) they say

it is a different Aetna network. They say we can use our Insurance

out of Network, by paying 1000 deductible then they will cover 30% of

treatment after that leaving us with the remaing 70%. I told them

that we really just need one visit, that after that we would just

have Dr. Ponseti coloberate w/ Dr. Herzenberg and we would remain

with him, etc. that we really are just asking for a 1 time in person

visit. They said what we need to do to fight them is Go to Collin's

peditrician (who doesn't even deal w/clubfoot...doesn't make sense),

have her call the Insurance company and tell them that she feels it

is of medical neccessaity that we see Dr. Ponseti and that there is

no one else around here qualified the same, etc. Then she has to put

it in writing, they then will investigate it themselves and see if

they believe what the peditrician is saying. If they find it to be

true then maybe they will allow us an exception and consider it in-

network. I explained to the insurance company that we are seeing Dr.

Herzenberg who is out of network for us but they allowed him to be in

network because no other doctors do the ponseti method around here,

etc. so I feel that we already proved there are no qualifed doctors

around here or we wouldn't have gotten approval to have Dr. H,

etc...but she said we still have to go by the books and start all

over again, etc.... I heard that if you just go to Dr. Ponseti w/ no

insurance it is like 300.00 for the visit and 160.00 for x-rays, it

seems like that is easier to do then pay 1000 out of network

deductible for us if we don't get it approved. I have to now get a

hold of the peditrician and talk to her next to see what shes willing

to do for us now before we can go any further. If I were financially

stable I think I would just take the angel flighs out ther stay in

the ronald mcdonald house and just pay the 300 out of pocket so I

didn't have to be on the phone all day fighting, but were not right

now so I'm going to try to battle this week and next week and see

where it gets me before trying to come up with the extra money. But

to give hope to others we did win the battle to see Dr. Herzenberg

and he is great, so I know it is possible to win again. Good Luck to

all of those trying to get approval and fighting these beaucratic

insurance companies who just care about the money, etc.... I think

sometimes just hang up leand call right back and you'll get someone

else that might care enought to help you then the person you spoke

with 5 minutes before, It's frustrating but being persistant seems to

get your further.

MIchele