This takes some explanation, so here goes.
I recently moved from RI to CT, so my son's state med coverage
changed. The cf clinic told me they were still going to see vincent
instead of changing clinics. When choosing the health plan (I had
four choices), I chose according to who would let me go out of
state (back to RI) for clinic visits. The clinic said they would
accept payment from this plan. Two months into it, I get a letter
from the state saying I need prior authorization to go out of state
for healthcare, or they will not pay. The clinic fills out the
necessary forms, but is denied (I get the letter this past
tuesday). I ask if I should appeal or just switch to the CT clinic,
and am told by the clinic to appeal. They want to continue with
Vinny's care, and I would like to stay there. Also, the RI clinic
is 30 min. away, the CT one is 1 hr and 10 min. away. It's actually
closer to go to RI, since I live right on the border.<br>
Anyway, now that you're caught up, we go to
clinic today because in the middle of all this Vin has a
pretty bad cough/wheeze that won't clear up after a month on
meds, but he isn't culturing anything. The doc thinks this
cough/wheeze may be asthma. He gave me an inhaler for Vin, and
if he's not doing better by Monday, its probably not asthma and we
will be admitted to the hospital that our doc has privileges at, in
RI. He also says Vin may need a bronchoscopy while there. On top of
that, he says he can not give me the letter stating that it is
'medically necessary' to continue Vin's care (that's what I would
need for an appeal), so I will probably have to switch
clinics.<br>
All this is enough to make me cry at the
visit because I don't know whats up with my baby and he has enough
problems with having cf and I don't want him to have asthma on
top of it, and I am scared to go the hospital again after seeing
how much weight he lost at last years hospitalization with RSV,
plus he caught staph and rotavirus while there, and I don't
want to leave our clinic. And these last two clinic visits that we
had because he's sick may not even be covered by insurance
because its out of state, and I don't know if they'll pay for a two
week hospital stay either. But the doc told me not to switch while
we're in the middle of trying to figure out whats wrong and treat
it. This could end up costing me so much money that I definately
don't have because the insurance people keep telling me I
don't have prior authorization to go, but the doc has me come in
twice for sick visits, and now maybe the hospital too. I can't wait
for the bills to start rolling in.<br>
<i>I'm sorry I'm rambling on and on but I
needed to vent.</i> I'm anxious about Vin and now worried about
when these bills start coming in, the insurance is going to deny it
and the dr told me I needed to come in and he may tell me I need to
go to the hospital so what choice did I have, he needed to be
seen.<br>
Besides all of this, we got a flat tire on
the way to the clinic and were an hour late. What a day! I hope I
didn't bore you all, I'm just super worried. Vin hasn't had a
hospitalization yet, just when he had RSV and was dx with cf.
<i>What should I expect at the hospital? And anyone have any
advice on dealing with state med insurance?</i>
I recently moved from RI to CT, so my son's state med coverage
changed. The cf clinic told me they were still going to see vincent
instead of changing clinics. When choosing the health plan (I had
four choices), I chose according to who would let me go out of
state (back to RI) for clinic visits. The clinic said they would
accept payment from this plan. Two months into it, I get a letter
from the state saying I need prior authorization to go out of state
for healthcare, or they will not pay. The clinic fills out the
necessary forms, but is denied (I get the letter this past
tuesday). I ask if I should appeal or just switch to the CT clinic,
and am told by the clinic to appeal. They want to continue with
Vinny's care, and I would like to stay there. Also, the RI clinic
is 30 min. away, the CT one is 1 hr and 10 min. away. It's actually
closer to go to RI, since I live right on the border.<br>
Anyway, now that you're caught up, we go to
clinic today because in the middle of all this Vin has a
pretty bad cough/wheeze that won't clear up after a month on
meds, but he isn't culturing anything. The doc thinks this
cough/wheeze may be asthma. He gave me an inhaler for Vin, and
if he's not doing better by Monday, its probably not asthma and we
will be admitted to the hospital that our doc has privileges at, in
RI. He also says Vin may need a bronchoscopy while there. On top of
that, he says he can not give me the letter stating that it is
'medically necessary' to continue Vin's care (that's what I would
need for an appeal), so I will probably have to switch
clinics.<br>
All this is enough to make me cry at the
visit because I don't know whats up with my baby and he has enough
problems with having cf and I don't want him to have asthma on
top of it, and I am scared to go the hospital again after seeing
how much weight he lost at last years hospitalization with RSV,
plus he caught staph and rotavirus while there, and I don't
want to leave our clinic. And these last two clinic visits that we
had because he's sick may not even be covered by insurance
because its out of state, and I don't know if they'll pay for a two
week hospital stay either. But the doc told me not to switch while
we're in the middle of trying to figure out whats wrong and treat
it. This could end up costing me so much money that I definately
don't have because the insurance people keep telling me I
don't have prior authorization to go, but the doc has me come in
twice for sick visits, and now maybe the hospital too. I can't wait
for the bills to start rolling in.<br>
<i>I'm sorry I'm rambling on and on but I
needed to vent.</i> I'm anxious about Vin and now worried about
when these bills start coming in, the insurance is going to deny it
and the dr told me I needed to come in and he may tell me I need to
go to the hospital so what choice did I have, he needed to be
seen.<br>
Besides all of this, we got a flat tire on
the way to the clinic and were an hour late. What a day! I hope I
didn't bore you all, I'm just super worried. Vin hasn't had a
hospitalization yet, just when he had RSV and was dx with cf.
<i>What should I expect at the hospital? And anyone have any
advice on dealing with state med insurance?</i>