Neurology information needed for PANDAS insurance appeal

[PANDAS mom in Nebraska]

Hello! My daughter was dx with PANDAS last fall. I had been working closely with Dr. Kobayashi, an immunologist in Omaha who has been awesome. He referred us to a neurologist to have a "neurologist on board" in case we needed one for future use. My daughter was referred in January, but not seen until April (At which time she had been doing great). The neurologist we saw told me that if this were her daughter she would NEVER treat her with steroid burst or antibiotics and told me that she didn't know the doctor who dx (dr. K in Chicago), but there was not a doctor around here that believes in PANDAS. She said my daughter just had typical OCD and should be taken to a psychiatrist ASAP. (Again despite being great with no psych meds). A long story short, we did not have mental health coverage at the time on our independent policy. THe neurologist ends up coding the visit mental health so we are being charged $514 out of pocket for a neuro consult in which we were referred to get by the immunologist. I have fought with the neurologist to change the code of the visit which she won't. The immunologist is going to dictate a letter to go along with my appeal. But what other information would be good to include to prove the neuro aspect of PANDAS to go in my appeal. I am fired up!!

[thereishope]

I thought the new mental health bill says that mental health has to be covered the same as "regular health". I didn't think you'd need separate mental health coverage.

 

Have you spoken to billing at the hospital instead of the neurologist? That's ridiculous he won't change it.

Edited August 26, 2010 by Vickie

[norcalmom]

Did your daughter gave any tics, or chorea?

[kimballot]

Vickie - good idea with the parity law - I looked it up, though, and it looks like it has several exceptions. Here is some info. - there are fact sheets if you page down. https://www.cms.gov/healthinsreformforconsume/04_thementalhealthparityact.asp

 

Your State may have stronger parity laws.

 

I agree with NorCalMom - Prior to the parity law, my son had many visits covered because there was documentation of tics in his pediatrician's medical file. Even if it is just a hand written note somewhere in the medical file, you should be able to get it covered.