"network" PANDAS provider

[momslove]

Our current insurer has located a provider they called "preferred" and told us we could request prior authorization to see her rather than our current provider. They denied any coverage for our current PANDAS doctor. We are not wanting to change doctors, but would consider another opinion. When I googled the name they gave us, I found no indication of interest or expertise with PANDAS/PANS even though that is supposedly what the insurance nurse navigator was seeking for us.

 

I'm wondering if anyone has experience with a pediatric neurologist in the University of Wisconsin Hospital system. Perhaps, you could message me and we could share contact names and any recommendation you might have.

 

Otherwise, can I get some guidance on questions to ask BEFORE scheduling anything to make sure we would not be wasting our time and money?

[nicklemama]

Why don't you ask the nurse navigator to provide you with documentation that this physician is, in fact, a PANDAS expert.

[pr40]

Our current insurer has located a provider they called "preferred" and told us we could request prior authorization to see her rather than our current provider. They denied any coverage for our current PANDAS doctor. We are not wanting to change doctors, but would consider another opinion. When I googled the name they gave us, I found no indication of interest or expertise with PANDAS/PANS even though that is supposedly what the insurance nurse navigator was seeking for us.

exactly the same thing happened to us with Harvard Pilgrim in Boston. You can leave a message with dr, explain your situation. dr can, actually, be helpful to you if she/he wants, for instance, to refer you to your current dr. or, at least, speak with insurance about that.

I would start with a message, some drs do try to be helpful.