I am about a year into treating my son James for Autism. I have found that my insurance will basically pay for almost nothing. He does receive state medical insurance but the 'Developmental Pediatrician' I keep getting refered to by our pediatrician doesn't take EITHER. Seriously is it 500 a visit. We just DONT have the money for out of pocket expenses like this. Can anyone recommend how to navigate this system. I called some DAN doctors in Phoenix (we live outside city) and the story is the same. Help? Johanna
what insurance do you have?
Can you tell your Ped all of this and have him refer to someone else who does take your ins?
I have also at times called the Doc (nurse, tutor) and asked them if they were willing to barter their services.
what can I say? i was a desperate Mama.
Thanks! Those are some creative ideas. We have Blue Cross Blue Shield HMO. I will try to get my pediatrician to give me some other options for doctors who might take our insurance. Thanks again, Johanna
If you find that there's NOT a specialist covered under your HMO, then you can appeal to the insurance company based on medical necessity. You would need a well-written letter from your child's referring physician stating the medical need to see this particular specialist and why the services your child needs is outside the scope of his/her own office. Try to see how many miles it is to any covered specialist, and if it's too far, state how many miles away it is. Insurance companies, even HMO's, have to consider situations like these. However, if there is another specialist available in your area that is on the insurance plan, you would have no recourse with the insurance company.
If you happen to get services approved with the insurance company for a doctor who is not covered on their plan, you would most likely have to pay out-of-pocket for the visit, file the claim yourself with the insurance company, and then get reimbursed directly for your expense.
If you find that there's NOT a specialist covered under your HMO, then you can appeal to the insurance company based on medical necessity. You would need a well-written letter from your child's referring physician stating the medical need to see this particular specialist and why the services your child needs is outside the scope of his/her own office. Try to see how many miles it is to any covered specialist, and if it's too far, state how many miles away it is. Insurance companies, even HMO's, have to consider situations like these. However, if there is another specialist available in your area that is on the insurance plan, you would have no recourse with the insurance company.
If you happen to get services approved with the insurance company for a doctor who is not covered on their plan, you would most likely have to pay out-of-pocket for the visit, file the claim yourself with the insurance company, and then get reimbursed directly for your expense.
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