Guest guest Posted January 17, 2004 Report Share Posted January 17, 2004 Hi Meg, Thanks for responding. We were using a group that worked at Hackensack. They are wonderful, but saddly they can't accept my insurance. There was a lot of talk about becomming an official center. We visit Columbia once a year and may need to consider going there for all regular visits. It really is a difficult decision to make. Just when we were getting settled and getting accustomed to everything. They say things happen for a reason, I just worry about making the wrong decision. And Channa loves her doc's and it is going to be so hard on her. When I mentioned it to her she was heartbroken. Pattie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2004 Report Share Posted January 17, 2004 Pattie, Where are you in NJ? I am in NY about 5 mins from the Woodbury Commons and 15 from West Point. My kids go to the CF clinic in Columbia. I heard Hackensack Medical has an excellent center. You might want to look into that. Meg Mom of 3 2wcf Quoting MUNCH313@...: > Hi everyone, > > Just a quick question. Currently my daughter sees a Pulm. and > Gastro. which > are not associated with a CF Center. They diagnosed her and have > given her > excellent care. Just got word that they are not longer accepting my > insurance. > They suggest opting out of my policy and just use her medicaid > through SSI. > The red flag goes up for me on that. I think that would be a bad > move. We > attend Columbia in NY once a year for a " second opinion " so to speak. > I am not > ready to pick new doctors out of a network book, I have issues > trusting > doctors. So I was wondering if anyone here is from New Jersey and > could suggest > some doctors. Or also if anyone has any views on taking her to > Columbia > regularly. Any suggestions would be help. > > thanks. > Pattie > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2004 Report Share Posted January 17, 2004 > They suggest opting out of my policy and just use her medicaid through SSI. > The red flag goes up for me on that. I think that would be a bad move. This just prompted me to ask how many of you have medicaid for your CF child? I hate when they change insurance carriers on you. Ours did that not long ago but fortunately his pediatrician was covered. Becaue the hospital where his CF doctor accpets the insurance we have, his CF docotr had to accept it as well. jan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 17, 2004 Report Share Posted January 17, 2004 My daughter w/CF is on Medicaid through her SSI, which we are about to lose because of my husbands income. Anyone have any suggesstions? His insurance through his employer will not cover most of her stuff. Her doc is considered out of network, and they don't have coverage for ANY out of network physician. Even though her doc is a CF doc at the ONLY accredited CF center in our state!!! Just venting, sorry!!! Katy mom to Austin 4 no CF & Piper 18 months w/CF najnest wrote: > They suggest opting out of my policy and just use her medicaid through SSI. > The red flag goes up for me on that. I think that would be a bad move. This just prompted me to ask how many of you have medicaid for your CF child? I hate when they change insurance carriers on you. Ours did that not long ago but fortunately his pediatrician was covered. Becaue the hospital where his CF doctor accpets the insurance we have, his CF docotr had to accept it as well. jan ------------------------------------------- The opinions and information exchanged on this list should IN NO WAY be construed as medical advice. PLEASE CONSULT YOUR PHYSICIAN BEFORE CHANGING ANY MEDICATIONS OR TREATMENTS. ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2004 Report Share Posted January 18, 2004 Jan, We had both medicaid and regular insurance for . The MA covered the co pays and what not. Unfortunately, our insurance, through my hubby's work, went up so much that we had to put on MA alone. Lucky for us, the CF clinics do accept MedicAid. Re: Insurance issues > They suggest opting out of my policy and just use her medicaid through SSI. > The red flag goes up for me on that. I think that would be a bad move. " This just prompted me to ask how many of you have medicaid for your CF child? " ------------------------------------------- The opinions and information exchanged on this list should IN NO WAY be construed as medical advice. PLEASE CONSULT YOUR PHYSICIAN BEFORE CHANGING ANY MEDICATIONS OR TREATMENTS. ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2004 Report Share Posted January 18, 2004 Katy, We were in an HMO that demanded we take Zach to a very bad cf doc who was in network. We worked with the pediatrician to refer us to an out of network clinic. They denied us and we appealed. I also contacted the our state's Department of insurance. Had the HMO denied our appeal we could have requested an independent review from the Dept of insurance. Luckily the bad cf doc was so bad that he didn't even write any office notes on Zach from our first visit. He could not submit anything to the insurance company, so they approved the out of network clinic. Since then Zach even got approved for an out of network ent and had surgery at the out of network hospital. Insurance companies make arbitrary rules without diseases like cf in mind. If need be have the pediatrican, pulmonologist, and any other doctors that she sees write letters stating that is important that she continue treatment at her current center. Insurance companies love to deny all claims and then the take a closer look at the ones that are appealed. We have switched to a PPO plan because the referral process was so nervewracking. The new plan costs more but we a lot more freedom. Good luck witht he insurance fight! Sara > > > They suggest opting out of my policy and just use her medicaid > through SSI. > > The red flag goes up for me on that. I think that would be a bad > move. > > This just prompted me to ask how many of you have medicaid for your > CF child? I hate when they change insurance carriers on you. Ours did > that not long ago but fortunately his pediatrician was covered. > Becaue the hospital where his CF doctor accpets the insurance we > have, his CF docotr had to accept it as well. > > jan > > > ------------------------------------------- > The opinions and information exchanged on this list should IN NO WAY > be construed as medical advice. > > PLEASE CONSULT YOUR PHYSICIAN BEFORE CHANGING ANY MEDICATIONS OR TREATMENTS. > > ------------------------------------ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2004 Report Share Posted January 18, 2004 Sara, Thanks for the info!!! If it comes down to needing to do what you did, atleast I know what I am in for. Thank you again!!! Katy mom to Austin 4 no CF & Piper 18 months w/CF dwson2 wrote: Katy, We were in an HMO that demanded we take Zach to a very bad cf doc who was in network. We worked with the pediatrician to refer us to an out of network clinic. They denied us and we appealed. I also contacted the our state's Department of insurance. Had the HMO denied our appeal we could have requested an independent review from the Dept of insurance. Luckily the bad cf doc was so bad that he didn't even write any office notes on Zach from our first visit. He could not submit anything to the insurance company, so they approved the out of network clinic. Since then Zach even got approved for an out of network ent and had surgery at the out of network hospital. Insurance companies make arbitrary rules without diseases like cf in mind. If need be have the pediatrican, pulmonologist, and any other doctors that she sees write letters stating that is important that she continue treatment at her current center. Insurance companies love to deny all claims and then the take a closer look at the ones that are appealed. We have switched to a PPO plan because the referral process was so nervewracking. The new plan costs more but we a lot more freedom. Good luck witht he insurance fight! Sara > > > They suggest opting out of my policy and just use her medicaid > through SSI. > > The red flag goes up for me on that. I think that would be a bad > move. > > This just prompted me to ask how many of you have medicaid for your > CF child? I hate when they change insurance carriers on you. Ours did > that not long ago but fortunately his pediatrician was covered. > Becaue the hospital where his CF doctor accpets the insurance we > have, his CF docotr had to accept it as well. > > jan > > > ------------------------------------------- > The opinions and information exchanged on this list should IN NO WAY > be construed as medical advice. > > PLEASE CONSULT YOUR PHYSICIAN BEFORE CHANGING ANY MEDICATIONS OR TREATMENTS. > > ------------------------------------ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2004 Report Share Posted January 18, 2004 Katy; this is awful; I do hope you can find a solution. Love, n Re: Re: Insurance issues My daughter w/CF is on Medicaid through her SSI, which we are about to lose because of my husbands income. Anyone have any suggesstions? His insurance through his employer will not cover most of her stuff. Her doc is considered out of network, and they don't have coverage for ANY out of network physician. Even though her doc is a CF doc at the ONLY accredited CF center in our state!!! Just venting, sorry!!! Katy mom to Austin 4 no CF & Piper 18 months w/CF najnest wrote: > They suggest opting out of my policy and just use her medicaid through SSI. > The red flag goes up for me on that. I think that would be a bad move. This just prompted me to ask how many of you have medicaid for your CF child? I hate when they change insurance carriers on you. Ours did that not long ago but fortunately his pediatrician was covered. Becaue the hospital where his CF doctor accpets the insurance we have, his CF docotr had to accept it as well. jan ------------------------------------------- The opinions and information exchanged on this list should IN NO WAY be construed as medical advice. PLEASE CONSULT YOUR PHYSICIAN BEFORE CHANGING ANY MEDICATIONS OR TREATMENTS. ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2004 Report Share Posted January 18, 2004 In a message dated 1/18/2004 7:35:41 PM Central Standard Time, great_yensen@... writes: This just prompted me to ask how many of you have medicaid for your CF child? I hate when they change insurance carriers on you. Ours did that not long ago but fortunately his pediatrician was covered. Becaue the hospital where his CF doctor accpets the insurance we have, his CF docotr had to accept it as well. jan My oldest is on Medicaid but my youngest is not because she does not have any damage to her lungs so they said she did not have a disability. Deb A Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 18, 2004 Report Share Posted January 18, 2004 you might try applying for share of cost medicaid through your local social services office you will have to p[ay a portion of it but it should pick up most of what your insurance doesn't and in some cases will even pay the insurance premiums for you. I know they do this in CA Maureen Re: Re: Insurance issues My daughter w/CF is on Medicaid through her SSI, which we are about to lose because of my husbands income. Anyone have any suggesstions? His insurance through his employer will not cover most of her stuff. Her doc is considered out of network, and they don't have coverage for ANY out of network physician. Even though her doc is a CF doc at the ONLY accredited CF center in our state!!! Just venting, sorry!!! Katy mom to Austin 4 no CF & Piper 18 months w/CF Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2004 Report Share Posted January 19, 2004 In a message dated 1/19/2004 12:09:08 AM Central Standard Time, kinipela2@... writes: Katy, Hello from VA! Have you thought about calling the point of contact at the CF Foundation in Bethesda, MD ... she is a lawyer, I believe, who works with families on patients rights, health insurance, etc ... last name is Suffian, I believe. If anyone out there in cyberspace has more specifics on the person I'm referring to, please chime in ... smile. Thanks. Jen Chastain Her name is Beth Sufian she lives in Houston Texas. She was in last year Tobi calendar she was the month of October. She is the sweetest lady! She has helped me a time or two. Ask Grandma Bev for her phone number that is where I got it. Deb A Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2004 Report Share Posted January 19, 2004 OUR ATTORNEY angel guardian :) BETH SUFAIN (wcf) info; 1--office # 1--fax BethSufain@... Passamano@... (hubby & partner-LAW FIRM) 811-Rusk Ave.,Ste 712 Houston, TX.77002 I hope this helps. This is info from her business card ----GOOD LUCK!! LOVE & HUGS, GrandmomBEv Re: Re: Insurance issues Sara, Thanks for the info!!! If it comes down to needing to do what you did, atleast I know what I am in for. Thank you again!!! Katy mom to Austin 4 no CF & Piper 18 months w/CF dwson2 wrote: Katy, We were in an HMO that demanded we take Zach to a very bad cf doc who was in network. We worked with the pediatrician to refer us to an out of network clinic. They denied us and we appealed. I also contacted the our state's Department of insurance. Had the HMO denied our appeal we could have requested an independent review from the Dept of insurance. Luckily the bad cf doc was so bad that he didn't even write any office notes on Zach from our first visit. He could not submit anything to the insurance company, so they approved the out of network clinic. Since then Zach even got approved for an out of network ent and had surgery at the out of network hospital. Insurance companies make arbitrary rules without diseases like cf in mind. If need be have the pediatrican, pulmonologist, and any other doctors that she sees write letters stating that is important that she continue treatment at her current center. Insurance companies love to deny all claims and then the take a closer look at the ones that are appealed. We have switched to a PPO plan because the referral process was so nervewracking. The new plan costs more but we a lot more freedom. Good luck witht he insurance fight! Sara > > > They suggest opting out of my policy and just use her medicaid > through SSI. > > The red flag goes up for me on that. I think that would be a bad > move. > > This just prompted me to ask how many of you have medicaid for your > CF child? I hate when they change insurance carriers on you. Ours did > that not long ago but fortunately his pediatrician was covered. > Becaue the hospital where his CF doctor accpets the insurance we > have, his CF docotr had to accept it as well. > > jan > > > ------------------------------------------- > The opinions and information exchanged on this list should IN NO WAY > be construed as medical advice. > > PLEASE CONSULT YOUR PHYSICIAN BEFORE CHANGING ANY MEDICATIONS OR TREATMENTS. > > ------------------------------------ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2004 Report Share Posted January 19, 2004 I know, I cannot type either, but this I do have right: Beth SUFIAN, not Sufain! Sorry, Bev! Love, n Re: Re: Insurance issues Sara, Thanks for the info!!! If it comes down to needing to do what you did, atleast I know what I am in for. Thank you again!!! Katy mom to Austin 4 no CF & Piper 18 months w/CF dwson2 wrote: Katy, We were in an HMO that demanded we take Zach to a very bad cf doc who was in network. We worked with the pediatrician to refer us to an out of network clinic. They denied us and we appealed. I also contacted the our state's Department of insurance. Had the HMO denied our appeal we could have requested an independent review from the Dept of insurance. Luckily the bad cf doc was so bad that he didn't even write any office notes on Zach from our first visit. He could not submit anything to the insurance company, so they approved the out of network clinic. Since then Zach even got approved for an out of network ent and had surgery at the out of network hospital. Insurance companies make arbitrary rules without diseases like cf in mind. If need be have the pediatrican, pulmonologist, and any other doctors that she sees write letters stating that is important that she continue treatment at her current center. Insurance companies love to deny all claims and then the take a closer look at the ones that are appealed. We have switched to a PPO plan because the referral process was so nervewracking. The new plan costs more but we a lot more freedom. Good luck witht he insurance fight! Sara > > > They suggest opting out of my policy and just use her medicaid > through SSI. > > The red flag goes up for me on that. I think that would be a bad > move. > > This just prompted me to ask how many of you have medicaid for your > CF child? I hate when they change insurance carriers on you. Ours did > that not long ago but fortunately his pediatrician was covered. > Becaue the hospital where his CF doctor accpets the insurance we > have, his CF docotr had to accept it as well. > > jan > > > ------------------------------------------- > The opinions and information exchanged on this list should IN NO WAY > be construed as medical advice. > > PLEASE CONSULT YOUR PHYSICIAN BEFORE CHANGING ANY MEDICATIONS OR TREATMENTS. > > ------------------------------------ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 28, 2005 Report Share Posted September 28, 2005 Hi, I have found that the best place to go FIRST is the HR department at the company where you have insurance (in this case your husband's). They should have notified you and may be able to help work with you. My husband's employer got the HMO and dental to cover my stepson who lives in Chile even though he doesn't have a SSN. So, whenever he comes to visit (every other year for several mo nths usually) it is medical city but he is covered - only because they helped. If you call and explain they MAY (depending on the compnay/person) be willing to help. They need to understand they should be responsible for absolute lack of notification but take a deep breawth before you call or like me you might offend them by yelling first > I just found out last week that my husband's employer changed > insurance companies, which is GREATLY going to impact the amount we > spend out of our pocket for . They did not inform us they > were doing this, and in fact, sent home new insurance cards 3 weeks > after the policy became effective. During that time period, we had 2 > doctor's office visits with a non-participating provider on the new > plan and ordered monthly medical supplies from a non- participating > DME provider. Of course, we wouldn't have done this had we known his > employer switched insurance coverage! > > We are going from an HMO (have always had one) to a PPO. I know most > people bash HMOs, but it has been a godsend for us. We already spend > a LOT of money on co-pays for doctors, pharmacy, hospitalizations, > diagnostic testing, etc. even with an HMO. This PPO is going to kill > us. The biggest cost we are facing is to cover durable medical > equipment (DME) expenses and I have no idea what is going to happen > with the GH & Lupron now. We finally got the HMO to approve a Zevex > Enteralite Infinity pump a little over a month ago, and now the DME > company we were using is not a provider under the PPO. It took us > months to get this pump covered. Now we have to start all over, and > here's the kicker - after meeting a $1000 deductible (in which co- > pays for covered services do not count towards), we then have to pay > 20% of the DME expenses. We paid nothing for DME on the HMO. Also > unfortunate for us, is that the effective date was 9/1/05. That > means we need to meet our deductible & maximum out of pocket expenses > for this year between now and 12/31, and then we have to start from > zero again in January. > > I have to admit I don't fully understand how a PPO works as I have > never had one, but I have read the benefits book from cover to cover > several times, and it doesn't look good for us. For anyone who has > had both an HMO and a PPO, which plan was most beneficial for your > child with extensive medical issues? Does it make sense for me to > add to my insurance policy to provide him coverage under 2 > policies? I am covered under my employer - not my husband's, and I > have an HMO for myself, but with a different company. My open > enrollment period is now, so I need to make a decision quickly. Does > anyone know how it works when you have additional insurance coverage? > We are already paying about $260/month for coverage of the kids on my > husband's plan. I'll have to pay another $410/month to add him to my > policy. Is it worth it? We don't qualify for Medicaid or any other > services, but I have read about others on this listserve who also > have health insurance & who get assistance from their state with > medical coverage that is not based on income. If you are one of > these people, how did you get this? > > I don't know about the rest of you, but I spend HOURS on the phone > with insurance companies, doctors, hospitals, etc. trying to get > things authorized, correct billing errors, and just get what my son > needs. It is extremely frustrating for me (lucky for the insurance > company I haven't had a nervous breakdown yet, as that would be more > expenses they would have to pay for my psychiatry fees - lol). But > all joking aside, sometimes I feel like I am not far off.... I am > sure some of you can empathize with me. To top it off, is > having surgery on Tuesday, and I have no idea what we will have to > pay for this with the new insurance. Sorry to vent for so long, but > I don't know how else to relieve some of this frustration! > > Kim C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2005 Report Share Posted September 29, 2005 hey kim!! we have had a PPO in the past and for us even though it cost more it was better because not all of christopher's dr were on the HMO plan but with the PPO we could go out of network and it would still be covered (we had to pay a little more then had we stayed in network, but it was worth it knowing i didnt have to change all of his drs!!) and we didnt need referrals either!! you may want to add him on to your this way what ever your husbands doesnt cover your will pick up the rest, if you can swing the extra cost. remember you can also deduct the amount paid for your insurance off of your income tax when you file next year!! good luck!! jodie c Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 29, 2005 Report Share Posted September 29, 2005 Kim, Along the lines of what Kim said, if you get a doc who's a dud, you have more options for changing under a PPO. Inga At 12:29 PM 9/29/2005 +0000, you wrote: >hey kim!! >we have had a PPO in the past and for us even though it cost more it >was better because not all of christopher's dr were on the HMO plan but >with the PPO we could go out of network and it would still be covered >(we had to pay a little more then had we stayed in network, but it was >worth it knowing i didnt have to change all of his drs!!) and we didnt >need referrals either!! you may want to add him on to your this way >what ever your husbands doesnt cover your will pick up the rest, if you >can swing the extra cost. remember you can also deduct the amount paid >for your insurance off of your income tax when you file next year!! >good luck!! > >jodie c > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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