Overwhelmed/Unsure in NY Anyone have Child Health Plus insurance for their child?

[maddy2815]

My daughter was diagnosed with a Chiari Malformation in September of 2012. She is 12 years old now. For the last month she's been having Chiari type headaches about every two weeks.  But since she switched from a backpack to a tote bag for school she hasn't had a headache.  

She currently has a neurologist near Westchester Medical Center.  We were referred to him by the ENT who discovered my daughter's Chiari. September was the last time that we went to the NL. He wants to monitor my dd every six months for scoliosis.  His office just got the approval from my daughter's insurance to do three MRIs of her back.  I would think it would be more important to do a CINE-MRI and other procedures that look at her head.

I have the paperwork filled out and just need to fax it to The Chiari Institute.  I would like my daughter to be seen there instead of by the NL we saw in Sept.  I have not made an actual appointment with the NL in Westchester yet.  I am just not sure if my insurance will cover the Chiari Institute.  My daughter has Hudson Health Plan with Child Health Plus.  They do not cover out of network providers.  They say that if there is someone in the network that can provide the service my dd needs they will not cover out of network.  I dont think the NL in Westchester can provide my dd with what she needs but I think The Chiari Institute can.  I am not sure if Hudson Health Plan will see it that way.  What can I do to convince them?  My daughter doesn't have many symptoms yet but I would like her to be evaluated by The Chiari Institute so I can have an idea about what we are dealing with.  I can not afford to pay The Chiari Institute out of pocket.  Could I find someone in the Hudson Valley Region that knows something about Chiari? Any advice would be appreciated.  Thank you.

[selmaS]

  U may be able to get TCI to tell u what testing she will need so it is all up to date and what they will want....plus that way ur INS will deff cover the testing...they did that for me as I was trying to get the testing to see if  I was someone they would see.

This can be very frustrating, and overwhelming as there are so many Drs that do not understand how Chiari affects us....but u r not alone.

Keep in mind whomever she is seeing now may not be able to determine if she is a surgical candidate ...but u can get her checked for related conditions.

[maddy2815]

Thank you for your replies. I appreciate it. I guess I might need to see a ns if my dd turns out to need surgery. I will call tomorrow and see what our options are. I don't think I want to go to the nl in Westchester though. If I get MRIs done there, insurance probably won't cover more necessary procedures done with another nl or ns. I am feeling pretty overwhelmed.

[selmaS]

  Thanks for that update on the info and how to get it, as I said it has been a while since I was up there and actually used the site.....it is good to know they list the Ins  they work with on the site.

[derek1983]

if you go on their site and click on the doctors names under their info at the bottom is a list of ins they accept i just went through this with them and am having my surgery on the 20th out of network but as far as ive been told they will work with you on payment etc good luck hope all goes well with your dd

[selmaS]

  Hi....most of the NS's at TCI do not work with INS at all.....and u pay out of pocket for the visit...but the NL and other staff that u may see in connection do take INS. I know there is one NS at TCI that does work with INS....so u may want to call and speak with the financial office to see if ne of them work with ur INS and how u might be able to get her seen by them.

I was there 4 yrs ago and things have changed as I mentioned there is one Dr, (he is the new Dr in charge at TCI) that does take INS.....but when I went I asked about those that do not have INS or can not afford to got to their office I was informed that they (all the NS's ) do work in the hospitals clinic and those that go there get the same care.....so something to consider.