New Doctors-- T and all

[Guest guest]

I am so saddened to read how somany of ya'll havve such incredibly

difficutl times getting the apprpriate care you need. and the

rest of ya'll; Do you have a case manager at your heath insurance

company. If not, then callthem and get one. Case managers are often

nurses who can help you find physicians that are specialist in a

field but may ormay not be within your network. The case manager can

arrange to have you be treated by thhis physician and your insurance

company will pay for.

If there is a specialist that a patient needs for specific reasons

then the claim can be allowed. They prefer you use an in network

physician because they are paid to do so, its called capitation.

Sometimes if you use an out of network physician the only difference

may be an increase in your co-pay lets say $30 instead of $10. These

arrangements can all be made by a case manager.

I am so sorry that you are feeling so badly lately. I wish

there was something I could do to help. I know why you were not a

candidate for the tp-ict but why not the Whipple. Also When you

first told me of the reason you were denied the islet transplant I

got in touch with one of the liver docs I used to work with. He is

in charge of the liver tranplant team at MUSC and he said that

sometimes the condition you described can improve. Have you

discussed this with any of your physicians?

If you have a casem anager, then call her, if you dont then get in

touch with your ins co and request one. My ins co denied my surgery

at Cincy 2 weeks before the scheduled date for the operation. I was

devestated to say the least. Then they assigned a case manager to

me. Within 3 days I was back on the schedule.

I wish I could do more to help you. Just have faith that there are

good physicians out there who aren't so easily intimidated by a

complx condition such as chronic panreatitis. I hope you all can

find sombody very very soon. I have been blessed with the treatment

I have had with MUSC and its affiliates. If youcould come south, I

would recommend them whole heartedly.

I truly hope you are feel better soon and will pray that each of you

get the care you deserve.

Warmly,

[Guest guest]

's advice is what I would have advised myself, but she beat

me to it! My insurance company is BlueCross/BlueShield. They will

and do assign case managers to people like us, people that have

multiple problems with lots of claims needing to be made. I was

assigned a case manager three years ago, when it became apparent that

I was going to be a constant claim filer with the insurance company,

because of my CP.

My case manager has helped me numerous times, to find doctors, approve

meds that the doctors prescribed that the insurance company didn't

want to allow, like Protonix instead of Zantac or Prevacid, Duragesic

instead of generic fentanyl, or approval for my extensive dental

surgery being done in a hospital all at one time, when the insurance

company originally wanted to let the teeth rot one at time, and THEN

make piece by piece repairs! My case manager fought with the

insurance company to make these things happen, and to make sure that I

was getting the best care possible. Almost all insurance carriers

have this service available, but you often have to ASK for it.

Chrissy's got the right idea and one that may help many of you. I

don't have any problem with my PM doctor, and he does prescribe

schedule II narcotics. He's the second one I've had that does

prescribe, and he is covered by my insurance company. Keep trying,

folks, it can work if you keep looking.

With love, hope and prayers,

Heidi

Heidi H. Griffeth

SC State & SC Regional Rep

PAI

Note: All comments or advice are based on personal experience or

opinion, and should not be substituted for consultation with youre

medical professional.