|
|
Post by Honeysmom on Jun 22, 2004 16:44:49 GMT -5
I have had it with insurance companies, doctors, and most of all HMO's!  Since yesterday morning I have made 27 (yes 27) phone calls trying to get someone to eval. Honey for Autism. They insurance co is not help, they doctor is out of ideas, and that stupid HMO that goes with the insurance is run by people who are trying to make me go insane. I am starting to think there is a conspiercy. So, this afternoon I lost it and I filed a complaint with the Omsbuds people who deal with our insurance. She even called me back, and in 48 hours a nurse case worker is going to call me to set up a eval. plan. I don't believe that it is going to happen, and if it does not I have decided (I probably should ask DH) that we are going to pay for the testing ourselves. I got some info from one clinic, and I get the feeling I will be paying until I am about 73 years old, or bankrupt, whichever comes first. Every person or company tells me that I have to have a dx before we see them, call the ins. co. The ins. co says oh sorry, call this place, and it is a never ending circle of phonce calls. So call #27 was to the Omsbudsman people. I really hate to make =waves, but I am at a loss on this one. Didn't I just to through this like 6 months ago?? Oh no, it was seven, I guess I am due for a good fight.  Becky |
|
|
|
Post by Amsmom on Jun 22, 2004 17:11:51 GMT -5
Good for you Becky---more power to you!!! 26 phone calls in 24 hours with no results is inexcusable!! I work for a state agency that regulates health care and the ombudsman have been a tremendous help to many people. Don't worry for a second about making waves. If the HMO had been responsible in their duties, you wouldn't have had to call the ombudsman. I'd say 7 months is a looong enough chance. ((((((((Becky)))))))) Keep us posted Honey sure is lucky to have you!!!  |
|
|
|
Post by rosyred45 on Jun 22, 2004 17:29:46 GMT -5
I'm sorry to hear this Becky, we had a time when I was prego with Mikey, the insurance didn't cover pregnant wives, so we would have had to kick in 80 dollars every week for me to have it covered  couldn't afford that at the time, so we went through the clinic.  I don't know how HMO's work, we've always had PPO's, where we get a good list and pick from there. There are a lot covered in our area for our insurance, so it's been a blessing. How in the world are you supposed to get a dx if you can't get the appointment to get it? Sounds stupid to me. ((((((((((((HUGS))))))))))))) for Becky Hope things start going smoother |
|
|
|
Post by Honeysmom on Jun 22, 2004 20:14:46 GMT -5
Thanks to both of you. I hope the Omsbudsman are some help. I didn't get a call this afternoon, but I am sure that they also have other things to do, so maybe tomorrow.
Kaiti, Be glad that you have a PPO!! In an HMO you need a referral for everything that your primary care physician cannot do. Then, if you get sent to a specialist with a referral and they want to do tests, your PCP has to approve them and usually you have them done right at the regular clinic. Then (since I am so lucky) the specialist doesn't want to accept them. It is supposed to be more cost effective, but I really wonder. The amount of times that I have to call the family doc alone is enough to make a person cringe.
Becky
|
|
|
|
Post by aimee30 on Jun 22, 2004 20:37:24 GMT -5
I have never had a HMO, but I can't say much for our PPO ins. either. Especially since I have started trying to get a dx for DD. It seems I get a run around all the time. They don't want to pay for anything (and aren't). It amazes me! I am so fed up with our ins. comp. right now it is unreal. Anyway, I know how you feel.
I do hope they contact you soon and can get something done for you. I wish you luck! Keep us posted. I would love to know the specifics. Maybe I can try something with my ins. comp.
|
|
|
|
Post by finnmom on Jun 23, 2004 3:07:58 GMT -5
Go Becky Dont be afraid of making wawe´s... it´s your job as a good mom It´s no harm to memorice them that you KNOW what they are supposed to do and WILL fight for getting it if have to 27 call´s... I bet your ear´s keep still ringing ;D (((((((((((((((((((hug´s and strength))))))))))))))))))))))))))) Marja |
|
|
|
Post by catatonic on Jun 23, 2004 9:31:42 GMT -5
Becky, you keep on them, just like a bull dog! Eventually you'll wear them down. It seems to me the insurance companies routinely turn things down and most people go "Oh, okay". The insurance companies save money just by being obstructionist. But if you don't let them get away with it, they usually cave in. I know it's frustrating, but your persistence will surely pay off in the end.
I don't understand, though...why can't your pediatrician simply refer you to a neurologist for an evaluation for possible autistic spectrum disorder?
|
|
|
|
Post by rosyred45 on Jun 23, 2004 10:36:37 GMT -5
Amiee, where did you say you were again? The way we did it, which I know there are a few that have gone to AI DuPont to see the pediatric Neurologist, she was wonderful.
Anyhow, their clinic was paid just like an office visit, just the copay. BUT I know how you feel Becky, as I am remembering, I would call the ins. they would tell me to find a Nuero, and ask them if they excepted it. HELLO, isn't that why it says on the card to call this number for doctor's in the area? No help. Went round and round with the staff at AI, until I spoke to one lady, after I was in tears, she says OH no, we would be just like an office visit.
Man, brings back some memories that didn't need to happen if the person knew what they were talking about to begin with
|
|
|
|
Post by Honeysmom on Jun 23, 2004 11:25:48 GMT -5
Our insurance company needs a referral for everything. He was referred to a neorologist, but the reason given was "possible autism," then the ins co deined it saying that we had to go to the Autism clinic. OK fine, now which one, and that is where the circle started. Our family doc is new in the state and is still learning the ins and outs of the rules for the insurance and really is not much help, and now that we are in this stupid HMO I am stuck with him for 2 more months. I am trying to get my mom to help me with this. She just took a new IT job with the company, but she used to the be (until last month) claims director for a major health insurance comapny and knows how all this crap works and how to get around it, but she is mad at me and won't return my calls. Sometimes she is as childish as they come. I wish she'd grow up and realize that it isn't just about me and help me for Honey's sake. My dad is out of town for work, but when he gets back I'm telling on her and hopefully he'll calm her down. I found out that I can take him to one place, but it is in Deluth MN for treatment after a dx, 5 hours from here, and the first open appt for a new patient is February! By that time we have wasted how many more months and I still would need a dx. I'm still waiting for my call back. Maybe this afternoon. Becky |
|
|
|
Post by rosyred45 on Jun 23, 2004 11:31:18 GMT -5
oh boy, that is a ways away I think that we waited 5 months after making Mikey's appointment. It was an eternity. (((((((((((hugs))))))))))) for ya Becky |
|
|
|
Post by AnneM on Jun 23, 2004 11:49:22 GMT -5
{{{Becky}}} I don't understand the HMO and PPO terminology but what I DO understand is that you are working your butt off to get this done for Honey! ... WHAT a Mum !! ... But HOW frustrating to find yourself going around in circles and potentially having to pay such a lot of money out of your own pocket! ...
Becky ... you WILL get there ... in the end all this effort will pay off and you WILL get there ... and never ever feel bad about pulling "all the stops" (like the ombudsman) ... those people are there for this very reason!
GO BECKY GO !! (although I think you already are!!)
{{BECKY}}
|
|
|
|
Post by Linda on Jun 23, 2004 18:09:14 GMT -5
Becky...did you get your call?Need my broom? |
|
|
|
Post by Honeysmom on Jun 24, 2004 9:43:11 GMT -5
No I did not get a call. I am waiting until noon and then I will have to get out a broom. Actually, I just gone my own so I should probably break it in...  Becky |
|
|
|
Post by Dakotah on Jun 24, 2004 10:54:58 GMT -5
Hi Becky- I have been lurking on this sight since it started. I had to put in my two cents on this one. We have had major insurance issues also. First I am not sure how old honey is or how far into school he is. If he is still under the "early childhood" catagory within the schoold district- does your schoold district have an Autisim team? Our school district does- no insurance needed. Also some states have "Autism Society of (state)" which would come to you with help. I am sorry if this is all info you have already thought of and gone over.
Hey- I just reread some of your posts- Are you in MN?
|
|
|
|
Post by HooDunnit on Jun 24, 2004 12:13:28 GMT -5
Hi Lezlie and welcome to the forums.
|
|
