PANDAS/PITANDS doc's in DC/N. VA area who take Insurance?

[DonnaD]

Anyone know of a good doc who takes insurance and who also know what they're doing as far as testing, etc? I'm in MD/VA/DC area.

[Kayanne]

Dr. Latimer is in Bethesda, MD. Her office takes payment upfront, and then bills your insurance as "out of network"...you may get some of it reimbursed. She may even be in your network.

 

She is one to the top PANDAS docs...if you are nearby, I wouldn't hesitate to see her because in the long run, you may pay more by visiting several docs who don't treat or are not as familiar with PANDAS.

 

However, keep in mind that she has been out for personal reasons, and may not have regular office hours for a while.

Edited July 13, 2010 by Kayanne

[matis_mom]

Yes, I heartily recommend Dr. Latimer too! Our insurance has been reimbursing almost 100% even though she is out of network for us.

But, yes, she will not be in for a while and probably will be booked.

Maybe you can work with your pediatrician to do the initial testing and start trying some antibiotics? I know it's hard to find a good pediatrician... We are booting our current pediatrician after many disappointments and are switching the kids to our own family doc, who incidentally has had a few PANDAS kids. She is no expert but is willing to help out. All the bloodwork is covered by insurance.

[DonnaD]

Yes, I heartily recommend Dr. Latimer too! Our insurance has been reimbursing almost 100% even though she is out of network for us.

But, yes, she will not be in for a while and probably will be booked.

Maybe you can work with your pediatrician to do the initial testing and start trying some antibiotics? I know it's hard to find a good pediatrician... We are booting our current pediatrician after many disappointments and are switching the kids to our own family doc, who incidentally has had a few PANDAS kids. She is no expert but is willing to help out. All the bloodwork is covered by insurance.

 

Thanks for reply....Our's is UHC PPO. Your's is covered 100% out of network...wow... What's your insurance?

[rockytop]

We have Cigna HMO- but they reimburse quite nicely for most visits at Dr L- not the first visit so much- as it is quite a bit more (understandably) I am in NVA, if you want to PM me- I am not so great at responding to the forum- I have 2 children with pandas.. maybe I can help you somehow. (or at least tell you what NOT to do:) I have been blessed by some amazing help here!

Emily

[matis_mom]

Yes, I heartily recommend Dr. Latimer too! Our insurance has been reimbursing almost 100% even though she is out of network for us.

But, yes, she will not be in for a while and probably will be booked.

Maybe you can work with your pediatrician to do the initial testing and start trying some antibiotics? I know it's hard to find a good pediatrician... We are booting our current pediatrician after many disappointments and are switching the kids to our own family doc, who incidentally has had a few PANDAS kids. She is no expert but is willing to help out. All the bloodwork is covered by insurance.

 

Thanks for reply....Our's is UHC PPO. Your's is covered 100% out of network...wow... What's your insurance?

We have CIGNA through Fairfax County (I think different employers offer different levels of coverage).

But if you have another insurance, there was a thread somewhere saying if your insurance does not have a specialist in network who can handle the case (i.e., a pediatric neurologist with PANDAS experience), they should cover is as in-network since they are unable to provide a suitable alternative.

Someone in this forum went through the process, I believe. Basically you get the list of in-network providers, call them up and see if they have the required experience, and after you have crossed everyone out, you can call and plead your case. Maybe someone can chime in with more specifics.

 

In any case, I would not waste any time. Call and make that appointment now, you'll be glad you did. I know in the beginning of this journey we got quiet the sticker-shock with all the extra doctor's bills, supplements, etc. Somehow we managed and now we have come to accept it as part of our new reality.

[peglem]

I was one who got Dr.L covered at in-network rates ($35 copay to see specialist). We got it pre-approved because the local pediatric rheumatologist sort of accidentally referred us! We paid up front, but they reimbursed us pretty quickly after we submitted the paperwork.