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Posted by: mlb828 ® 12/31/2008, 10:52:48 |
Hi all,
I have not visited this site in a while. I am struggling to find a doctor in Phoenix that my insurance will cover. I get very excited when I think I have found someone only to be knocked down when I call and find out they will not take my insurance. I don't know if I can mention what insurance I have, so I will refrain at this time. Any suggestions of doctors in the Phoenix area would be greatly appreciated! I have already been diagnosed with SD and would like to find a doctor to administer the botox injections. I currently have an appointment at the Mayo Clinic for next week, but they will not take my insurance! Very, very frustrated! Thanks for any help that may be forthcoming, Marsha . |
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Posted by: hoarse whisperer ® 12/31/2008, 19:56:08 |
The best place to look for medical professionals (ENT doctor, neurologist, speech therapist, etc.) with experience diagnosing and treating SD or other voice disorders is on the NSDA website at www.dysphonia.org and then click on the Healthcare Referrals link on the top menu. I've provided the link, but there's also a link to the NSDA site at the top of the main SD bulletin board page. Good luck! Lori
Related link: http://www.dysphonia.org/healthcare/ |
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Posted by: wolfe ® 12/31/2008, 20:22:26 |
I lead kind of a sheltered insurance life, so maybe this is a dumb question but, when they say they won't take your insurance does that mean the doc's office won't file the claim or that the doc's office knows your insurance won't pay? If they won't file the claim then you just get the paperwork and file it yourself. That is how my companies have worked. If the doc says your insurance won't pay I would think you need to talk to your insurance company. |
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Posted by: irish ® 12/31/2008, 23:47:53 |
Hi there,
I know of a few people who have had difficulty with their insurance not paying and also clinics/doctors not accepting their insurance. This can be very costly for the patient. The worst offender has been Aetna insurance on the basis that treatments for SD are experimental and the Mayo Clinic has not accepted certain forms of medicare because they want the benefit of higher payments. I'm a fighter and my inclination would be to challenge it privately and if that doesn't work publicly. In these times, no place wants to get a bad reputation. If you are in need of botox injections and money is an issue, you can apply for and may qualify for a free year's supply through Allergan. Good luck,
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Posted by: hoarse whisperer ® 01/01/2009, 12:24:33 |
Hospitals, doctors, etc. negotiate and contract with different insurance companies for the cost of services. If they don't have a contract, then the doctor's office can't file a claim. A patient can still pay and then file a claim, but it is generally processed as "out of network" and the benefits (amount paid back to you) is much less. If they determine that there was an "in-network" physician or facility that you could have used, your claim will most likely be denied. I went through this with one insurance company - they couldn't understand why I couldn't go to just any ENT doctor. Lori
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Posted by: mlb828 ® 01/02/2009, 11:36:29 |
Lori, you are exactly right. I have been told #3 times about a doctor in network only to find out later that they do not take Aetna. I plan to fight this and keep my appointment at Mayo this Wednesday.
One thing I will say is that the nurses who do the pre certification with Aetna are very helpful and supportive. Two of them have told me to file an expedited appeal and I plan to do just that. Thanks to everyone on the BB! Marsha ADSD |
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Posted by: Laurie ® 01/02/2009, 19:42:41 |
Out of network coverage must be very different in Texas and Arizona than in NYC. PPOs in New York have in-network and out of network benefits and a patient could get all his/her care out of network if so desired (even if there were 100 in-network doctors who could treat the disorder). It is the patient's "choice" if he/she wants to see an out of network doctor. The only time you run into problems in NYC w/ out of network care is with EPO's and HMO's... where you are forced to find an in-network doctor if one exists (versus PPOs and POS where it is 100% your choice even for super-routine care and no referall is even required for out of network coverage, specialists or general care). Many out-of-network MDs file the claims for the patient. Granted, there are deductibles and co-insurance, but some PPOs have good out of network reimbursement schedules (based on a nationalized formula, not something the insurance company makes up itself). While one of the most expensive (with astronomical premiums) in the country, the health insurance regulations in New York, New Jersey, etc. favor the patient moreso than some other states when it comes to access to care. One of the zillion reasons why I'll never move to a state without these sort of plans and protections, guaranteed issue laws, community rating, etc. Overall, I just wanted to point out that it is often the case that you absolutely can go out of network *even if* there are 5 alternative in-network doctors that can treat you. In some states and under some plans, it is 100% your choice if you have a true open access PPO with out of network benefits. BUT it all depends on your contract (and State in which you reside). My co-worker never uses in-network doctors (even for simple care from internists, GPs, etc.) as he has had the same MDs for years and won't give them up. Good luck though. And if you're ever told to see Dr. X who accepts your insurance and is in-network (I'm assuming you are in one of these highly restricted plans), just immediately pick up the phone and confirm coverage with that MD. Or go on Aetna's website and look it up based on your exact plan. Find it all out fast so you aren't thrown in circles and can immediately re-contact your insurance company. It is your right - especially when you need the treatment to function. Insurance companies often bank on the fact that patients are not fully aware of their rights. Unfortunately, unless you know state law, the exact provisions of your contract and exactly how to assert your rights (and what they are in the first place), they can, Aetna or whoever, legally (sadly) throw you in circles and deny your claims. If you get your insurance through an employer or a spouse's employer (or even some private Medicare plan), open enrollent is a good time to consider moving onto another plan which while possibly more expensive will more adequately suit your needs without endless warfare. Laurie Modified by Moderator-LC at Fri, Jan 02, 2009, 20:13:49 |
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Posted by: steveweiss ® 01/01/2009, 20:03:56 |
I had been treated by Dr. Bansberg at Mayo Clinic but will no longer because Mayo Clinic will no longer accept my insurance, nor will they allow me to pay out of pocket, as I offered to to do. The only other ENT doc in Phoenix who treats SD patients is Dr. Orosco, who doesn't have nearly the experience treating SD that Dr. Bansberg does. There are two docs in Tucson who treat SD but I decided to see Dr. Berke in L.A. who has considerable experience in treating SD. |
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Posted by: mlb828 ® 01/02/2009, 18:32:16 |
Just wondering if your insurance covers Dr. Berke? Do you live in the Phoenix area and travel to see Dr. Berke?
I am willing to travel for treatment, but I have to wonder what the insurance group would say about that. Marsha ADSD |
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Posted by: steveweiss ® 01/03/2009, 19:41:02 |
My insurance covers any doc willing to see me. Yes I traveled to L.A. to see Dr. Berke, logistics weren't too bad. |
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Posted by: lhaman ® 01/05/2009, 17:53:59 |
I have Aetna and had no luck with their approved Dr. My medical group denied my request to go to an out of area doctor. I appealed to Aetna and was eventually approved to go to Dr. Berke at UCLA. I am in San Diego, so it is not bad. Keep fighting! I have found that if you keep at it, eventually you will find someone who is sympathetic and willing to go to bat for you. Good luck! |
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Posted by: mlb828 ® 01/09/2009, 18:22:12 |
Good news on my insurance fight. After many, many phone calls, I have won the fight with Aetna! They have finally agreed that there are no doctors in the Aetna network and have given me the go ahead for the doctors at the Mayo Clinic in Phoenix/Scottsdale. I appealed based on the fact that there is a discrepancy within the network. So, the squeaky wheel finally got some much needed oil. I have my first appointment On January 28 with Dr. Bannsberg, ENT, and a speech pathologist. If my previous diagnosis of ADSD is concurred with by Dr. Bannsberg, I will have my first injection on February 4. I am a bit nervous, but looking forward to the next step.
Thanks to all for your support and for those having trouble with insurance, in the words of Jimmy V, don't give up, don't ever give up! Marsha ADSD |
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