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KrisTie H.

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Joined
Jan 8, 2016
Messages
15
Reason
CALS
Diagnosis
01/2016
Country
US
State
Utah
City
Taylorsville
Hi............Sorry. haven't been able to be here for awhile I spent 7 day's in hospital with heart failure then had to return to the hospital 3 time's after I was discharged...

Anyway's had my husband a apt @ U of U clinic but they called to confirm insurance and told me that our insurance was not in their network we would have to pay outta pocket... And it could reach 45 Thousand dollars for just this year.... so I called the neurologist and she was suppose to call m back to tell m where I could take him thats was covered on our insurance, that was over a week ago......he has an apt on the 7th so i figure she is just waiting to speak to us face to face....
in the mean time he saw our family Dr last week and he pretty much confirmed that it is MND, and he would be referring him to the neuro that he saw for his full time care from this point on.....
He is getting worse and I see it everyday I can't hardly understand him anymore and his balance is terrible... is it time to apply for our insurance benefit for long term disability or short term.... ????
I know we have to wait for SSI or SSDI and it may not be approved for 6 months. I don't think he can continue working for much longer even though he loves his job and dose not wanna leave it. And they are being really good to him, I wont be able to return to work for about 4 more week's depending on how enlarged my heart still is..... Please help with any info Thank you.....:shock::???:
 

lgelb

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Messages
7,932
Reason
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Diagnosis
09/2009
Country
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State
WA
City
Seattle
Kristie,
Your plan should have a physician directory on line; you don't have to wait for your neuro and it's not really their job.

But your neuro should write or call your plan and explain that U of U is the only ALS center in your area and therefore reimbursement of an out of network clinic is justified. Or call your plan and ask for a case manager, then go over this with her and get documentation from your neuro if needed. Use phrases like "facilitate coordination of care for a complex patient."

Very sorry about your own CHF. Have you consulted the ALSA or MDA in your area -- there is usually a nurse or social worker that can help you apply for local services if you don't yet have an official diagnosis to apply for disability/Social Security. Or you may be eligible for home health in your own right (ask your cardiology office), and they usually have social workers on staff.

Best,
Laurie
 

KrisTie H.

Member
Joined
Jan 8, 2016
Messages
15
Reason
CALS
Diagnosis
01/2016
Country
US
State
Utah
City
Taylorsville
Thank you Laurie, I talked to the insurance and he is 100% covered and his new apt is in May.... If it hadn't been for reading your reply I wouldn't have ever thought about calling the insurance myself.......Thank you again..................
 

affected

Guru status reached
Joined
Apr 26, 2013
Messages
12,045
Reason
Lost a loved one
Diagnosis
05/2013
Country
OZ
State
AU
City
lala land
Kristie it's great that you go the help you needed here!

How are you doing, are you recovering ok?
 

KrisTie H.

Member
Joined
Jan 8, 2016
Messages
15
Reason
CALS
Diagnosis
01/2016
Country
US
State
Utah
City
Taylorsville
still waiting for surgery. Cardio Dr tomorrow, we shall see...........Thank you again......Alway's K.Harris
 
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