Fighing Insurance, etc

[Guest guest]

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, 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