How do you get an insurance to let you go somewhere else?

[RobNDenver]

I really feel for your situation, and unless we get some real control over insurance companies, it will never get any better. Kaiser is pushing you around because they know that they can. The other insurance companies in the market are no different and will treat you the same. Frankly, I'd rather see a health care market where everyone is covered under Medicare or a similar program.

For those who tell me that they don't want the government coming between them and their doctor, I ask them how they feel about an insurance executive doing just that? Discussion usually ends as soon as I say that. . .

The only suggestion that I have about trying to get Kaiser to send him to another hospital is to contact your state's Division of Insurance and see if there is a provision in Washington law that would permit you to have your disagreement with Kaiser mediated. Talking completely out of my hat here, but there may be consumer protections that the state could take in your behalf.

Good luck.

 

[ALCapshaw2]

Maybe you ARE shooting yourself (and your son) in the Foot by NOT telling the contact Nurse that you work in an Adult CVICU and the head surgeon there thinks your son needs to be evaluated by a Pediatric Cardiologist / Surgeon.

Whenever you encounter nothing but rejections, you need to get to someone at a level who has the background and authority to say YES. Otherwise, you are just wasting your time and energy.

Keep Pushing for a Proper Evaluation.

 

[Cozycat]

Well, I just lost about a whole page I wrote you so will try to condense this. Guess I took to long to write my first answer.

1. Use what you've got, which is your employment with Kaiser. If it does some good that will be wonderful; if it does not, nothing lost.

2. Read thru your guidebook on the appeals, further appeals and possibly mediation.

3. I'm a member of Kaiser Senior Advantage and had good luck at their cardiac unit in Los Angeles....but, again, it is an adult facility. Keep plugging for trying to go to another facility of theirs that has a cardiac peds unit.

4. Been there and done that with no insurance. Husband had a tumor on his abdominal aortic artery and had to have it removed before they could remove his prostate for pretty advance cancer. We had no insurance and he spent days on the phone calling his surgeon, the hospital, anesthelogist and anyone else he would need to ask for discounts if we paid cash, paid in advance, anything to reduce the bill. He reduced it by about 40% from our first estimates and the hospital was 50%. They even sent us a refund about a month after surgery. By the second surgery--prostate removal--we had some insurance thru the state high risk pool....but the premiums were sky high.

Keep plugging, keep looking, keep asking...it emotionally draining and takes alot of patience when you have kids at home and are working, but it may be the only way.

My thoughts and prayers will be with you.

Midge

 

[delvalle6]

I took my son to his regular pediatrician (who is fabulous). He said that he's "no cardiologist" but believes that my son is more sensitive to the heat because of his heart condition and that if the fatigue continues when the temperatures drop to get him in immediately. He also noted that twins can often sense when something is wrong with the other and that may be why his twin refuses to leave his side--that I should pay attention to the "instinct of mother" and "of the twin". He said to me exactly what I wanted to hear from the pediatric cardio department at the hospital- but couldn't get them to say. Basically he told me to keep him cooler and try to get him to be active in the cooler setting. If he still doesn't want to move around- then there is a problem.

I feel better for the moment, but think that it is time for me to really research the options. My husband and I are seriously talking about relocating to be close to a hospital we approve of and getting a job close to it (or there) in order to have insurance that covers that hospital. With the economy, this will be a challenge, but I think it would be well worth the effort.

 

[RobNDenver]

I'm so glad that your pediatrician is looking out for your son and gave you such good advice. Best of luck in the job search, I know that is pretty tough these days.