darn HMO is not allowing my daughter to see the specalist!

[waggy]

I have a 2 month old daughter who has had seizures and had to be airlifted to a hospital in Rockford IL to see a pediatrician neurosurgeon.

Well today we had a fallow up but the HMO we have denied the request to see him. They said since they have a different neurosurgeon in the HMO we have to go see him (this one is in ST. Louis IL) which is a roughly 5 hour drive.

Insurance is great but it sucks when crap like this happens.

 

[Spooner]

sorry to hear that

 

[rahvin]

Originally posted by: waggy
I have a 2 month old daughter who has had seizures and had to be airlifted to a hospital in Rockford IL to see a pediatrician neurosurgeon.

Well today we had a fallow up but the HMO we have denied the request to see him. They said since they have a different neurosurgeon in the HMO we have to go see him (this one is in ST. Louis IL) which is a roughly 5 hour drive.

Insurance is great but it sucks when crap like this happens.

So pay for it out of pocket. (good luck with your daughter, hope she feels better)

 

[StageLeft]

Goodluck with mini-ms-waggy

 

[LemonHead]

Originally posted by: waggy
I have a 2 month old daughter who has had seizures and had to be airlifted to a hospital in Rockford IL to see a pediatrician neurosurgeon.

Well today we had a fallow up but the HMO we have denied the request to see him. They said since they have a different neurosurgeon in the HMO we have to go see him (this one is in ST. Louis IL) which is a roughly 5 hour drive.

Insurance is great but it sucks when crap like this happens.

That sucks. What HMO is it??

 

[Viper GTS]

I love my PPO, I can go see a specialist without referral.

But given the options, I'd say start driving.

5 hours is a PITA, but quite doable in one day.

Viper GTS

 

[Mister T]

yup HMO blows...
PPO good

 

[waggy]

heh paying out of pocket would be fine IF i didnt already pay for the premium for it. the HMO (health Alliance) so far has been pretty good but this is just really sucks.

We have a appointment tommorow morning (wich we are paying for) in rockford and there is a slim chance we wont have to go see him again.

only good part is since i work out of the home i dont have to beg for time off!
think i have family down there maybe i can introduce myself and stay with them overnight 10 hour round trip is way to much driving for me to do.

 

[Linflas]

Originally posted by: Mister T
yup HMO blows...
PPO good

Agreed. I have always taken the PPO option even though it costs more for this exact reason. I will see what doctors I want when I need to and if they don't cover the full cost I pay the difference.

 

[StageLeft]

think i have family down there maybe i can introduce myself and stay with them overnight

"Hey jim? We're third cousins - yes we are. Trust me, we are. Look I know you've never heard of anyone in my family before but we ARE third cousins. So anyway can I stay with you tonight? I'll be bringing along my brand new daughter and she cries a lot at night but she's pretty cute!"

 

[waggy]

Originally posted by: Linflas

Originally posted by: Mister T
yup HMO blows...
PPO good

Agreed. I have always taken the PPO option even though it costs more for this exact reason. I will see what doctors I want when I need to and if they don't cover the full cost I pay the difference.

ahh didnt know that. might see about changing then.

 

[waggy]

Originally posted by: Skoorb

think i have family down there maybe i can introduce myself and stay with them overnight

"Hey jim? We're third cousins - yes we are. Trust me, we are. Look I know you've never heard of anyone in my family before but we ARE third cousins. So anyway can I stay with you tonight? I'll be bringing along my brand new daughter and she cries a lot at night but she's pretty cute!"

HAHAH it would be worht it just to see the look on there faces

though i do have to say she sleeps most of the night so thats good but yeah she is cute!

http://home.attbi.com/~bwag6 for some really bad pics =)

 

[Kevin]

Sorry to hear.

Sounds like John Q. which I ironically just finished watching about 30 mins ago on DVD.

 

[Doggiedog]

Hope your daughter gets better and that nothing is wrong.

It's the worst feeling in the world as a parent to see your child(ren) suffer.

 

[tcsenter]

You know, at first you're thread title implied your HMO was preventing you from getting a specialist for your dauther's condition, but then I read they are sending her to another pediatric neurologist. So they're really not not allowing your daughter to see a qualified specialist, right?

 

[waggy]

Originally posted by: tcsenter
You know, at first you're thread title implied your HMO was preventing you from getting a specialist for your dauther's condition, but then I read they are sending her to another pediatric neurologist. So they're really not not allowing your daughter to see a qualified specialist, right?

htey will send her to a pediatric neurologist but one that is a 5hr drive there. There is one about 20 min drive from me (which we have been seeing for the last month and yes insurance has paid).

i just cant understand why they would make us drive a 10 hour trip for a doctor when there is one here.

actually yes i can understand why i just dont agree with it.

 

[The Stigenator]

here in CA I believe that if a HMO specialist is farther than one who is equally qualified but out of network then the HMO is to pay for all charges relating to that non networked specialists.

Look into if your HMO has something like that in a clause.. 5hrs is like 350miles .. they are nuts..

 

[rgwalt]

Chi town to St Louis is quite a drive... The worst part is there isn't much along the drive. I hope your daughter is OK.

Ryan

 

[thebestMAX]

I just cancelled my HMO for similar reasons and suggest you do the same if at all possible.

They refused me a prescription and an Opthamologist visit even after my PHP reccommended it. HMOs suck.

 

[MomAndSkoorbaby]

What is the difference between a HMO and PPO? (Stupid one here, not familar with US insurance!)

 

[HappyPuppy]

When I had Kaiser many years ago I needed to see an eye/ear/nose/throat specialist. I live in Los Angeles. No problem, right? There's gotta be dozens of them working for Kaiser in the Los Angeles area. WRONG! The bastages made me drive all the way to San Diego to see the specialist. Needless to say my family and I have a PPO now. Screw HMO's. They give people the runaround while they're deathly sick or dieing.

Sorry for starting to rant.

Hope your daughter is diagnosed and gets proper treatment.

 

[Viper GTS]

Originally posted by: MrsSkoorb
What is the difference between a HMO and PPO? (Stupid one here, not familar with US insurance!)

Here you go

Viper GTS

 

[Pliablemoose]

Has anyone come up with a cause for the initial seizures?

 

[waggy]

Originally posted by: Pliablemoose
Has anyone come up with a cause for the initial seizures?

Nope. all test have come back clear. EEG, Ct scan, spinal tap etc.

Though we have found out the other day that my wife's dad and uncle had the same thing happen to them at the same age (No permnant damage). So it might be in the family.

we go in tommrow for a blood test to see how much phenobarbital she has in her system ( sopposed to stop the seizures). So he might say take her off since we havent had one since she went up a few weeks ago.

 

[heartsurgeon]

i am a physician, and the single most important issue to me is being able to chose any doctor, anywhere i want, to take care of me and my family.

when you pick an HMO to provide your health care - you are trading off freedom of choice, typically for lower insurance premiums (or lower cost to your employer)
physicians who belong to HMO's have either agreed to provide you care at a discount rate to the HMO, or are part owner's of the HMO itself - which means that those doctors make more money when you need/get less care, and make less money when you "utilize" their services. they get particularly grumpy about "out of network" doctors, because they have to pay them their full fee.

you get what you pay for..

another thing to keep in mind.. the "specialist" your HMO doctor sends you to isn't chosen because he/she is the "best" at what they do - they are chosen because the HMO has a contract with them. In business, the "low bid" usually wins the contract.