Insurance hell...

[Guest guest]

Hi,

I guess this is a sign of what is to come! Emerence's dr called

FRiday (and I ended up seeing her with Eme that night b/c she was

running a fever up to 103.7 on Motrin! - diagnosis hand,foot and

mouth which she coincidentally must have picked up 2 days previously

in the waiting room for her 18 mo checkup - GGGGRRRRR. However,

today she finally was fine and no more projectile vomiting (she

doused herself the dr. and I friday - it was so not fun)

Anyway, back the original item, our insurance Blue Cross Blue Sheild

of MA called the dr. and left a note saying the " referral out of

state has been denied because the syndrome is incurable and

untreatable " . My dr. had given me a referral to see Dr. H in

Chicago in case I needed it in the beginning of July and we never

heard a word about there being a problem. She had put that EMerence

was being evaluated for RSS. So, get this, RSS referrrals are not

covered b/c there is nothing to be done??? So, what diabetics

shouldn't get insulin because diabetes is incurable! Is this crazy

or WHAT! EMerence, according to Dr. H, has SGA with asymmetry. My

dr. was annoyed and just told me to jump on it now so she can do

whatever battling it takes to get me the right to see whomever I

choose. And, the endo at Children's HOspital Boston (thanks though

for the warning from the MA people at the conference) was, shall we

say, COOL, to the idea that Dr. H suggested GHT if Emerence didn't

hit 3% by next summer. I printed out the 18 pages of their RULES on

GHT and it is not covered for RSS but covered for SGA so I think we

are safe there unless they change in a year. AGGGGHH! I hate this

health care system and Blue CRoss is supposed to be one of the best

for MA! Any ideas how to rationalize with this man!!!!!

Thanks, sorry for the venting!

, mom to 4.5 going on 15, and Emerence 18 mo, was 18.1

but has definitely lost after this weekend, 28.5/29 " and SGA - Small

Girl with ATTITUDE!

[Guest guest]

,

Sorry to hear about your insurance frustrations. I certainly have had my own

share! I also

have BC/BS, but I have an HMO (Health Options). I was able to get authorization

to see Dr.

H out of state with no problems (surprisingly). I live in Florida. Do you have

an HMO or a

PPO? I do know that Dr. H billed BC/BS of New York and then they were supposed

to get

reimbursed from the state of Florida. You need to keep calling the insurance

company,

and if Emerence doesn't have a case manager, you might find out whether she

qualifies for

one. If not, you should ask to speak to a supervisor when you call the

insurance company

& explain the situation. A letter saying it is medically necessary for Emerence

to see Dr. H

from her pediatrician and/or endocrinologist might help. Good luck!

Kim C.