MD Question: Yale

[szcasey]

Hi,

 

Does anyone have experience with Dr. Leckman at Yale New Haven, CT?

 

Does he take insurance? Does he provide IVIG?

 

Please feel free to pm me. Thanks!!

[pr40]

yes. we do. he is very cautious about IVIG. we moved to one of the other PANDAS drs. I am not sure if he can function as your primary PANDAS dr. you can ask.

he may be better for severe cases.

one thing he did not do for us is check other possible infections in addition to strep, like lyme. so, his approach seems to be limited. but he was also crucial in turning the tide on PANDAS and writing that PANDAS symptoms list.

About insurance, no. they don't take any. but we did get reimbursed by Harvard Pilgrim. its around $700 for one visit.

if you have specific question, feel free to ask

[szcasey]

Thanks so much for your response!

 

$700 is steep. I'm trying to rein in the costs. What doctor do you see for Pandas?

 

Thanks again!

 

Best,

 

Sarah

[Hopeny]

There is a long wait list but Dr B in Darien, ct takes insurance.

[szcasey]

Thanks! We currently see Dr. B. He is dropping CIGNA as of 9/15 ( according to CIGNA as his contract is good for another 3 years; his office says otherwise).

 

New infusion company will begin soon, apparently CIGNA approves their immunology therapy. But office visits won't be covered by CIGNA.

 

We just can't afford more out of pocket expenses. I'm looking for another MD who takes insurance and provides IVIG. Not easy...

 

Thanks for your response.

[pr40]

we see dr B too. i am not sure how to get IVIG w/out going through dr B. I mean, you can get IVIG at many places but getting it covered is tricky. needs proper diagnosis. If you find a way, please post what you did.

you can call Lekhman's office and explain your situation.

Yale takes medicade if I remember correctly.

[JoyBop]

Maybe I can help shed some light on the discrepancy between what the insurance co and the doctors office is telling you. I work in a private doctors office so I have a lot of insight. Privates are free to accept patients for any insurance plan they wish and can change at any time. The office will contract with the company for a set fee schedule for a certain period of time. Often this is accomplished through large groups of physicians, but that is more than you need to know. In any case, a private practice will usually limit the number of patients they accept newly into the practice if their insurance doesn't pay very well. That doesn't mean they will kick out their existing patients with that plan but they can not afford to have greater than a certain percentage on those plans. Also, the office may choose to completely eliminate working with that company even though there may still be a contract iin place. The contract simply guarantees a fee schedule and terms of payment to the physician but in no way is the practice obligated to see their patients. I can tell you Cigna is a very poor payer in the state of MA but I have no idea how it compares to CT. In any case, always go by what the office tells you and not the insurance co in regards to what they accept. There are other times you listen to what your insurance tells you but this is not one of those times.

 

Ill give you a working example. Tufts is a big insurance plan where we live. The fee schedule is awful, they take way too long to pay, and do all kinds of obnoxious things to take monies back up to three years later. (Such as sending a form to patients a year later asking if a visit was related to an accident or workers comp. when the patient doesn't respond bc they don't understand or think the form was ridiculous, they take the money back from the doc. We have to bill the parients and they get made, ect) So we get fed up and refuse to take any new Tufts patients but we don't dump the patients that we have that have On it. One day we might decide to forget it all together and ask those tufts members to either switch plans or find a new doc. Hospitals and other clinics that accept federal funds do not have this freedom.

 

I know that was a long story but hopefully I can help shed some light on how some of these things work.

 

To answer your other question there are pandas savvy doctors that come in all different specialities and are scattered around the country. Maybe someone from your area could chime in a tell you who is good that might be in your area and accept your insurance.