Guest guest Posted June 29, 2005 Report Share Posted June 29, 2005 Welcome, Helen and Theo! I don't have any personal experience with the insurance fight, but I know that a number of parents have appealed to their insurance group for coverage (not sure about HMO's specifically) and won, and some parents are still in the fight as well. Hopefully they'll chime in for you. You can search the archives regarding this too, though it can be tedious to go through the archives now since there are so many messages. There is now a certified Ponseti doctor in Michigan. Dr. near Grand Rapids. I would recommend that you consider going to him for Theo's follow up appointments once correction is achieved to save yourself some long distance traveling. I am very curious as to why you chose to fly to Baltimore for treatments versus going to Iowa City? I'm so glad that Theo is doing well now. He is definitely in good hands with Dr. H! Thanks for sharing the note about the " garden variety clubfoot " comment- I got a chuckle out of that- though I'm sure you wanted to strangle the guy at the time! Best of luck with your insurance fight and we look forward to hearing about Theo's progress! & (3-16-00, left cf) http://ponseticlubfoot.freeservers.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2005 Report Share Posted June 29, 2005 Welcome, Helen and Theo! I don't have any personal experience with the insurance fight, but I know that a number of parents have appealed to their insurance group for coverage (not sure about HMO's specifically) and won, and some parents are still in the fight as well. Hopefully they'll chime in for you. You can search the archives regarding this too, though it can be tedious to go through the archives now since there are so many messages. There is now a certified Ponseti doctor in Michigan. Dr. near Grand Rapids. I would recommend that you consider going to him for Theo's follow up appointments once correction is achieved to save yourself some long distance traveling. I am very curious as to why you chose to fly to Baltimore for treatments versus going to Iowa City? I'm so glad that Theo is doing well now. He is definitely in good hands with Dr. H! Thanks for sharing the note about the " garden variety clubfoot " comment- I got a chuckle out of that- though I'm sure you wanted to strangle the guy at the time! Best of luck with your insurance fight and we look forward to hearing about Theo's progress! & (3-16-00, left cf) http://ponseticlubfoot.freeservers.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2005 Report Share Posted June 29, 2005 Hi ! Dr Ponseti told us about Dr , and said he was very good with newborns, but Dr P was concerned that he didn't have any experience with babies Theo's age (10 months). We chose to go to Baltimore as Dr P recommended Dr Herzenberg so highly and given neither my husband Pat nor I had much vacation time left after our maternity/paternity leaves and so couldn't stay there for the weeks required. FLying back and forth is easier to Baltimore from here than to Iowa. Also we wanted to try to minimize disruption to our other kids, 8 and 5. BUT, I do hope to meet Dr P someday. I am in geriatrics, so corresponding with him was fantastic-- both on a personal and professional level! If anyone has any thoughts about the insurance fight, please share. I will go thru the archives as well. Helen and Theo > Welcome, Helen and Theo! > I don't have any personal experience with the insurance fight, but I > know that a number of parents have appealed to their insurance group > for coverage (not sure about HMO's specifically) and won, and some > parents are still in the fight as well. > Hopefully they'll chime in for you. You can search the archives > regarding this too, though it can be tedious to go through the > archives now since there are so many messages. > There is now a certified Ponseti doctor in Michigan. Dr. near > Grand Rapids. I would recommend that you consider going to him for > Theo's follow up appointments once correction is achieved to save > yourself some long distance traveling. > I am very curious as to why you chose to fly to Baltimore for > treatments versus going to Iowa City? > I'm so glad that Theo is doing well now. He is definitely in good > hands with Dr. H! > Thanks for sharing the note about the " garden variety clubfoot " > comment- I got a chuckle out of that- though I'm sure you wanted to > strangle the guy at the time! > Best of luck with your insurance fight and we look forward to > hearing about Theo's progress! > & (3-16-00, left cf) > http://ponseticlubfoot.freeservers.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2005 Report Share Posted June 29, 2005 Hi ! Dr Ponseti told us about Dr , and said he was very good with newborns, but Dr P was concerned that he didn't have any experience with babies Theo's age (10 months). We chose to go to Baltimore as Dr P recommended Dr Herzenberg so highly and given neither my husband Pat nor I had much vacation time left after our maternity/paternity leaves and so couldn't stay there for the weeks required. FLying back and forth is easier to Baltimore from here than to Iowa. Also we wanted to try to minimize disruption to our other kids, 8 and 5. BUT, I do hope to meet Dr P someday. I am in geriatrics, so corresponding with him was fantastic-- both on a personal and professional level! If anyone has any thoughts about the insurance fight, please share. I will go thru the archives as well. Helen and Theo > Welcome, Helen and Theo! > I don't have any personal experience with the insurance fight, but I > know that a number of parents have appealed to their insurance group > for coverage (not sure about HMO's specifically) and won, and some > parents are still in the fight as well. > Hopefully they'll chime in for you. You can search the archives > regarding this too, though it can be tedious to go through the > archives now since there are so many messages. > There is now a certified Ponseti doctor in Michigan. Dr. near > Grand Rapids. I would recommend that you consider going to him for > Theo's follow up appointments once correction is achieved to save > yourself some long distance traveling. > I am very curious as to why you chose to fly to Baltimore for > treatments versus going to Iowa City? > I'm so glad that Theo is doing well now. He is definitely in good > hands with Dr. H! > Thanks for sharing the note about the " garden variety clubfoot " > comment- I got a chuckle out of that- though I'm sure you wanted to > strangle the guy at the time! > Best of luck with your insurance fight and we look forward to > hearing about Theo's progress! > & (3-16-00, left cf) > http://ponseticlubfoot.freeservers.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2005 Report Share Posted June 29, 2005 Helen, Where in Michigan do you live? We are in the Detroit area and are seen at Children's Hospital in Detroit. What doctor are you seeing, if I may ask? We see Dr. Mendelow he has been using the Ponseti Method with great success for many years. Our son had bilateral clubfeet, our first doctor said he used the Ponseti Method, but did not and we had to switch doctors in order to get the right treatment for him. Our son is now 2 1/2 years old and is doing great. Still wearing his brace at night. If you have any questions feel free to ask me. If you feel more comfortable emailing me privately you can at bruceandcarolyn@... Carolyn and Bruce (11-17-02 blc) dealing with HMOs Hi- I am new to the group. I wondered if anyone had experience getting an HMO to pay for needed expert care out of state. In brief, our story is that our son, Theo, was born in August of 2004. We found out he had a severe right clubfoot in the delivery room, which now seems strange, given that I myself am a physician at an academic medical center and I had 4 ultrasounds while pregnant and it was never discovered. Theo also had apneas at birth and was in the ICU for 2 weeks. The apneas resolved and we were " left " with the clubfoot. Even though the pediatrician in the delivery room had pronounced the news of the clubfoot to us in the most somber tones, I looked at it as correctable and felt positive about the treatment. Unfortunately, my optimism and the early course with more concern about the apneas led us to assume Theo would get good care at our center. When the MD told us he had " trained with Ponseti " we took this at face value. After 6-7 casts and a posterior tenotomy, the MD put Theo in a non-standard AFO " because he has so much equinus " . My gut (as in your message!) told me something was very wrong, but we kept going. Long story short, of course Theo's foot relapsed and the MD now told us we should see a neurologist because Theo couldn't dorsiflex and " doesn't have the garden variety clubfoot " (whatever garden variety clubfoot is). Right then, I told myself that we were never going back to that doctor. I contacted Dr Ponseti himself who told me that no MDs in Michigan were qualified, that many say they " trained " with him but to get qualified is another matter. He highly recommended Dr Herzenberg in Baltimore who has been wonderful. Dr Herzenberg told us by looking at the AFO that Theo had been given as well as the casts we had saved that the treatment Theo had received had significantly deviated from Ponseti's protocol. He estimated that the MD had only gotten Theo to 30 degrees of lateral correction as opposed to the 70 degree standard. He noted that Theo couldn't dorsiflex due to the fact that the ankle bones were as yet uncorrected. As it stands now, we fly back and forth to Baltimore each week but after 4 casts, Theo is at nearly 70 degrees of lateral correction. He will need another tenotomy but we feel we are in excellent hands with Dr Herzenberg. We currently have appealed our insurance companies' rejection of treatment in Baltimore (they said " care could be provided at Michigan " ) by furnishing them with 17 pages of the history above with references, pictures (Theo's AFO vs. Denis-Browne brace) and articles by Ponseti and Herzenberg). Just wondered anyone else had success with appealing to an HMO and thoughts on the best approach. thanks! Helen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 29, 2005 Report Share Posted June 29, 2005 Helen, Where in Michigan do you live? We are in the Detroit area and are seen at Children's Hospital in Detroit. What doctor are you seeing, if I may ask? We see Dr. Mendelow he has been using the Ponseti Method with great success for many years. Our son had bilateral clubfeet, our first doctor said he used the Ponseti Method, but did not and we had to switch doctors in order to get the right treatment for him. Our son is now 2 1/2 years old and is doing great. Still wearing his brace at night. If you have any questions feel free to ask me. If you feel more comfortable emailing me privately you can at bruceandcarolyn@... Carolyn and Bruce (11-17-02 blc) dealing with HMOs Hi- I am new to the group. I wondered if anyone had experience getting an HMO to pay for needed expert care out of state. In brief, our story is that our son, Theo, was born in August of 2004. We found out he had a severe right clubfoot in the delivery room, which now seems strange, given that I myself am a physician at an academic medical center and I had 4 ultrasounds while pregnant and it was never discovered. Theo also had apneas at birth and was in the ICU for 2 weeks. The apneas resolved and we were " left " with the clubfoot. Even though the pediatrician in the delivery room had pronounced the news of the clubfoot to us in the most somber tones, I looked at it as correctable and felt positive about the treatment. Unfortunately, my optimism and the early course with more concern about the apneas led us to assume Theo would get good care at our center. When the MD told us he had " trained with Ponseti " we took this at face value. After 6-7 casts and a posterior tenotomy, the MD put Theo in a non-standard AFO " because he has so much equinus " . My gut (as in your message!) told me something was very wrong, but we kept going. Long story short, of course Theo's foot relapsed and the MD now told us we should see a neurologist because Theo couldn't dorsiflex and " doesn't have the garden variety clubfoot " (whatever garden variety clubfoot is). Right then, I told myself that we were never going back to that doctor. I contacted Dr Ponseti himself who told me that no MDs in Michigan were qualified, that many say they " trained " with him but to get qualified is another matter. He highly recommended Dr Herzenberg in Baltimore who has been wonderful. Dr Herzenberg told us by looking at the AFO that Theo had been given as well as the casts we had saved that the treatment Theo had received had significantly deviated from Ponseti's protocol. He estimated that the MD had only gotten Theo to 30 degrees of lateral correction as opposed to the 70 degree standard. He noted that Theo couldn't dorsiflex due to the fact that the ankle bones were as yet uncorrected. As it stands now, we fly back and forth to Baltimore each week but after 4 casts, Theo is at nearly 70 degrees of lateral correction. He will need another tenotomy but we feel we are in excellent hands with Dr Herzenberg. We currently have appealed our insurance companies' rejection of treatment in Baltimore (they said " care could be provided at Michigan " ) by furnishing them with 17 pages of the history above with references, pictures (Theo's AFO vs. Denis-Browne brace) and articles by Ponseti and Herzenberg). Just wondered anyone else had success with appealing to an HMO and thoughts on the best approach. thanks! Helen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 1, 2005 Report Share Posted July 1, 2005 Hi Helen, I just came across the following message (see link) in the archives. I'm in Canada so I'm not sure if any of it will help you with your fight with your HMO but it's worth a shot. Here's the link: http://health.groups.yahoo.com/group/nosurgery4clubfoot/message/34094 Hope this helps, Daiga and Owen, 02/04/03 Unilateral LCF, FAB 14/7 (nights & naps) > Hi- I am new to the group. I wondered if anyone had experience > getting an HMO to pay for needed expert care out of state. > > In brief, our story is that our son, Theo, was born in August of > 2004. We found out he had a severe right clubfoot > in the delivery room, which now seems strange, given that I myself am > a physician at an academic medical center and I had 4 ultrasounds > while pregnant and it was never discovered. Theo also had apneas at > birth and was in the ICU for 2 weeks. The apneas resolved and we > were " left " with the clubfoot. Even though the pediatrician in the > delivery room had pronounced the news of the clubfoot to us in the > most somber tones, I looked at it as correctable and felt positive > about the treatment. > > Unfortunately, my optimism and the early course with more concern > about the apneas led us to assume Theo would get good care at our > center. When the MD told us he had " trained with Ponseti " we took > this at face value. After 6-7 casts and a posterior tenotomy, the MD > put Theo in a non-standard AFO " because he has so much equinus " . My > gut (as in your message!) told me something was very wrong, but we > kept going. Long story short, of course Theo's foot relapsed and the > MD now told us we should see a neurologist because Theo couldn't > dorsiflex and " doesn't have the garden variety clubfoot " (whatever > garden variety clubfoot is). > > Right then, I told myself that we were never going back to that > doctor. I contacted Dr Ponseti himself who told me that no MDs in > Michigan were qualified, that many say they " trained " with him but to > get qualified is another matter. He highly recommended Dr Herzenberg > in Baltimore who has been wonderful. Dr Herzenberg told us by > looking at the AFO that Theo had been given as well as the casts we > had saved that the treatment Theo had received had significantly > deviated from Ponseti's protocol. He estimated that the MD had only > gotten Theo to 30 degrees of lateral correction as opposed to the 70 > degree standard. He noted that Theo couldn't dorsiflex due to the > fact that the ankle bones were as yet uncorrected. As it stands now, > we fly back and forth to Baltimore each week but after 4 casts, Theo > is at nearly 70 degrees of lateral correction. He will need another > tenotomy but we feel we are in excellent hands with Dr Herzenberg. > > We currently have appealed our insurance companies' rejection of > treatment in Baltimore (they said " care could be provided at > Michigan " ) by furnishing them with 17 pages of the history above with > references, pictures (Theo's AFO vs. Denis-Browne brace) and articles > by Ponseti and Herzenberg). Just wondered anyone else had success > with appealing to an HMO and thoughts on the best approach. > thanks! Helen Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.