View Full Version : Health Insurance Woes

02-02-2005, 10:00 PM
Hi our names are Cindy and Gregory. We have a 20 month old daughter named Ariana who was diagnosed at 4 months with congenital Kyphoscoliosis. She has had one surgery when she was 13 months old, a posterior spinal fusion of the T12-L2 area that we know now has failed. They did manage to correct her curve from approx. 52 degrees to 17 degrees, as of right now her curve is increasing again and it is approx 28 degrees with another surgery in our near future. My problem is all the best doctors dont take our insurance. It's not like we have bad insurance we have Aetna HMO, and believe me we pay a pretty penny for it, my husband is a nyc police officer. We used to have GHI and changed to Aetna because we were told it was better insurance and we have sooooo many problems now!!! I want to know does any one else have these problems? We just went to minneapolis to see Dr. polly, one of the leading specialists in scoliosis and paid $2000 out of pocket for the trip and cost of seeing him and the cost of x-rays because Aetna refused to pay, or even help us. they instead wrote us a letter and told us to see another doctor... I don't think that a pencil pusher in a health insurance company should tell me who I can and can not see!!! We are very frustrated... there is a doctor in ny we want to see who again doesnt take our insurance... any adive out there we dont want to pauper ourselves but we want the best for our daughter. Pls write back

02-02-2005, 11:40 PM
Hi there...

Sorry to hear about your problems.

I don't know much about this - I'm sure somebody else here will - but I did think of two things: first, whether you could try a Shriners' hospital, I believe they offer free care for under 18s (and there is a good one for scoliosis in Philadelphia); and second, whether you could try seeing a different (possibly out-of-state) surgeon who might be just as good but might accept your insurance. (Travel might be cheaper than treatment?)

I'm sure everyone will agree that you need to try and find the best possible care for your daughter. Hopefully some others here will also have some ideas.

All the very best ~Laura

02-02-2005, 11:41 PM
ps Maybe you should move or copy this post to the "Insurance" section or the section that deals with doctor recommendations - more people will see it there.

02-02-2005, 11:52 PM
Cindy and Greg,

I agree with the suggestion to see the orthos at Shriners in Philly. They are very well experienced with children (even infants) who have scoliosis/kyphosis issues. It it my understanding that Dr. Polly is NOT a pediatric ortho. In my experience, it is very important to see a ped. ortho who understands these situations in more detail. The fact that the first fusion failed tells me she needs someone who is an expert in the field. Dr. Betz and his associates (Dr. D'Andreas comes to mind) are wonderful. If I didn't live out west, I would trust them with my child's life, 100%.

Good luck and let us know how it goes. Insurance issues are NOT fun. There are a variety of appeals you could go through, but if you don't need to, its better for your emotional state. I know because we got on a plane and flew to Texas for my son's surgery KNOWING the insurance had denied the pre-authorization request. Thankfully the appeal process was expedited and the surgery went through as planned (insurance reversed their decision in about 24 hours). It can be done.

Mary Lou
02-03-2005, 06:44 AM
Cindy and Gregory,

I agree with Carmell....Dr. Betz or Dr. D'Andrea at Shriner's of Philly would be two great doctors to check into for your daughter. My 13 y.o. daughter was seen by Dr. Betz for her Kyphoscoliosis and although we chose someone else to do her surgery, it was a toss up between Dr. Betz and her current doctor, we were very pleased with Dr. Betz. He is a very patient, knowledgable man who will give you all the time you need with him to ask questions, etc.

Best of luck.

Mary Lou

02-09-2007, 12:01 PM
I am sorry to hear of your insurance situation and I realize that this is a little late on the post reply but just a quick idea. You may want to see if your husband's employer (police Dept) has a PPO/Network plan available as an option in addition to the HMO option. This would give you the freedom to choose to receive care from a physician or facility that is considered "out of network". (With an HMO you have to choose a physician that participates in the plan's network).