how many dr visits aloud

P

palinsyaya

New member
my grandson has been to the dr 3 times this week, 1st with the croup they said come back in 2 days if no better went back said it was a fever virus come back back in 2 days if still runing fever. went back the 3rd time said oh it looks like he my have a slight ear infection put him on amoxicillion. he is still running fever it will be 7 days tommorow. they allso said he is over his dr visits for the year only aloud 12 per year, he goes to cf clinic each month.has anyone else heard of this? he is on ms. medicaid.
so does this mean she has to paid for the visits the rest of the year?
 
P

palinsyaya

New member
my grandson has been to the dr 3 times this week, 1st with the croup they said come back in 2 days if no better went back said it was a fever virus come back back in 2 days if still runing fever. went back the 3rd time said oh it looks like he my have a slight ear infection put him on amoxicillion. he is still running fever it will be 7 days tommorow. they allso said he is over his dr visits for the year only aloud 12 per year, he goes to cf clinic each month.has anyone else heard of this? he is on ms. medicaid.
so does this mean she has to paid for the visits the rest of the year?
 
P

palinsyaya

New member
my grandson has been to the dr 3 times this week, 1st with the croup they said come back in 2 days if no better went back said it was a fever virus come back back in 2 days if still runing fever. went back the 3rd time said oh it looks like he my have a slight ear infection put him on amoxicillion. he is still running fever it will be 7 days tommorow. they allso said he is over his dr visits for the year only aloud 12 per year, he goes to cf clinic each month.has anyone else heard of this? he is on ms. medicaid.
<br />so does this mean she has to paid for the visits the rest of the year?
 
H

hmw

New member
Was he going to cf dr for each of those 'sick' appts? There should be a difference in billing between full cf clinic visits and any 'quick' visits for sickness where you don't see the full team. I would talk to the cf clinic social worker and see if she can get this worked out for you.

If insurance is very strict about what they will cover at the cf clinic you may be able to consult on the phone w/cf team when he gets sick to get started on the sick plan and monitor his progress and bring him to the ped. to get checked out initially if he's not getting well fast enough- there shouldn't be such a rigid 'cap' on sick visits to the pediatrician.
 
H

hmw

New member
Was he going to cf dr for each of those 'sick' appts? There should be a difference in billing between full cf clinic visits and any 'quick' visits for sickness where you don't see the full team. I would talk to the cf clinic social worker and see if she can get this worked out for you.

If insurance is very strict about what they will cover at the cf clinic you may be able to consult on the phone w/cf team when he gets sick to get started on the sick plan and monitor his progress and bring him to the ped. to get checked out initially if he's not getting well fast enough- there shouldn't be such a rigid 'cap' on sick visits to the pediatrician.
 
H

hmw

New member
Was he going to cf dr for each of those 'sick' appts? There should be a difference in billing between full cf clinic visits and any 'quick' visits for sickness where you don't see the full team. I would talk to the cf clinic social worker and see if she can get this worked out for you.
<br />
<br />If insurance is very strict about what they will cover at the cf clinic you may be able to consult on the phone w/cf team when he gets sick to get started on the sick plan and monitor his progress and bring him to the ped. to get checked out initially if he's not getting well fast enough- there shouldn't be such a rigid 'cap' on sick visits to the pediatrician.
 
P

palinsyaya

New member
no this was not to cf clinic this was his reg dr. this is what i was told to do if not cf related. i am beging to think this is a mrsa flare up. his reg dr says it is not it is only viral i will call the cf clinic on monday if he is still running a fever. his fever has got up to 104.
 
P

palinsyaya

New member
no this was not to cf clinic this was his reg dr. this is what i was told to do if not cf related. i am beging to think this is a mrsa flare up. his reg dr says it is not it is only viral i will call the cf clinic on monday if he is still running a fever. his fever has got up to 104.
 
P

palinsyaya

New member
no this was not to cf clinic this was his reg dr. this is what i was told to do if not cf related. i am beging to think this is a mrsa flare up. his reg dr says it is not it is only viral i will call the cf clinic on monday if he is still running a fever. his fever has got up to 104.
 
H

hmw

New member
Oh my!! This sounds wrong- to be capped to 12 visits a year total including both cf visits AND the pediatrician! <img src="i/expressions/face-icon-small-shocked.gif" border="0"> I would definitely have the cf social worker look into this and work on appealing this. That is not right, imo.

I'm so sorry that he is so sick and not only do you have the worries over dealing with the sickness but now also how to cover his dr appts for the rest of the yr.

I hope he is doing better soon. If he has resp involvement w/ this illness the cf dr is far more likely to know what is going on... the ped just doesn't know enough about cf to be able to tell you no. Esp if he is colonized with something like mrsa, which can cause nasty flareups. Wishing the best.
 
H

hmw

New member
Oh my!! This sounds wrong- to be capped to 12 visits a year total including both cf visits AND the pediatrician! <img src="i/expressions/face-icon-small-shocked.gif" border="0"> I would definitely have the cf social worker look into this and work on appealing this. That is not right, imo.

I'm so sorry that he is so sick and not only do you have the worries over dealing with the sickness but now also how to cover his dr appts for the rest of the yr.

I hope he is doing better soon. If he has resp involvement w/ this illness the cf dr is far more likely to know what is going on... the ped just doesn't know enough about cf to be able to tell you no. Esp if he is colonized with something like mrsa, which can cause nasty flareups. Wishing the best.
 
H

hmw

New member
Oh my!! This sounds wrong- to be capped to 12 visits a year total including both cf visits AND the pediatrician! <img src="i/expressions/face-icon-small-shocked.gif" border="0"> I would definitely have the cf social worker look into this and work on appealing this. That is not right, imo.
<br />
<br />I'm so sorry that he is so sick and not only do you have the worries over dealing with the sickness but now also how to cover his dr appts for the rest of the yr.
<br />
<br />I hope he is doing better soon. If he has resp involvement w/ this illness the cf dr is far more likely to know what is going on... the ped just doesn't know enough about cf to be able to tell you no. Esp if he is colonized with something like mrsa, which can cause nasty flareups. Wishing the best.
<br />
 
M

mom2cameron

New member
Wow this is crazy...my son is on oklahoma medicaid and I have never heard of only 12 visits a year.....i know we have went over that this year and last year! makes me want to look into it and see if we have a limit too. hope you little man gets to feeling better!
 
M

mom2cameron

New member
Wow this is crazy...my son is on oklahoma medicaid and I have never heard of only 12 visits a year.....i know we have went over that this year and last year! makes me want to look into it and see if we have a limit too. hope you little man gets to feeling better!
 
M

mom2cameron

New member
Wow this is crazy...my son is on oklahoma medicaid and I have never heard of only 12 visits a year.....i know we have went over that this year and last year! makes me want to look into it and see if we have a limit too. hope you little man gets to feeling better!
 
You must log in or register to reply here.
Top