Insurance Suggestions

[kimballot]

My current HMO has no out of network provisions. However, they do have an out of area variance that our primary MD can request. This allows treatment in another city if there is no one in our region who is able to treat the condition.

 

We are seeing Dr. B. My son has immune deficiencies and elevated C3Ds. I am concerned because there are certainly pediatric immunologists in my city who can treat immune deficiency, but none with PANDAS experience.

 

Since PANDAS is not an official diagnosis, I am going to ask the pediatrician to submit a variance stating that my son has immune deficiencies, an autoimmune disorder, and the DSM IV classification 293.84 Anxiety Disorder Due to a General Medical Condition. The idea being that there are no local immunologists who treat immune disorders that are resulting in an anxiety disorder.

 

I am wondering if anyone else has encountered anything like this and if you could offer some ideas. Thanks!

[peglem]

When we saw the local rheumatologist w/ our Cunningham results. He called Dr's Cunningham and Latimer, then refused to treat, saying he did not have the expertise to deal with it, but Dr. Latimer told him that she would be willing to see Allie. So he recommended we see her. I was able to turn that into a "gap exception" with UHC and they paid it (surprisingly quickly!) at in-network rates, so we just paid a copay. I did have pre-approval from the insurance company before the appt.

 

So, I think it would help if you had an in-network immunologist or specialist who would recommend Dr. B, on the basis that Dr. B has special expertise that can not be supplied by any in-network physicians.