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karla r

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Apr 30, 2015
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Learn about ALS
Country
US
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South Carolina
City
roebuck
My neurologist is sending me to ALS clinic for eval. She wants it done ASAP, because of the speed I seem to be going downhill. The problem is that of the 2 closest clinics, my primary insurance only covers 1 and my secondary insurance only covers the other one. Paying out of pocket is honesty out of the question. Does anyone know how to expedite the prior approvals that will be required for out of network doctors?
 
Is your current neuro doing the prior auth/ referral? Find out who in the office handles this and befriend them. It sounds like it may be one of those things that the doctor must speak directly with the reviewer doctor at the insurance company. But get to know that person and enlist their help. Make yourself a person in distress they want to help. There may be a time in the process for you to call your insurance as well but you need to know where things are or you will get we have no record of this or our doctor is waiting for a call back from your doctor
Additionally print out the insurance policies from each insurance. Read them understand how they apply and keep them.
Finally are either of these clinics MDA? I hear stories of how the MDA picks up copays for patients at some clinics. It is definitely not universal. My MDA clinic collects my ( hefty) copay every visit. But worth exploring to see if yours might help defray some of the cost
 
I will find out on the mda. The one at musc in Charleston is the only clinic here, although there is a specialist in Greenville, but for some reason, the neurologist did not want me to go there, but go to the actual als clinic. The other is at Carolina in Charlotte NC. It is actually closer. Neurologist is actually doing a referral to both, as she wants the first possible appointment. Told me to tell them when they call to give me the appointment that I want to be placed on the cancelation list, to possibly get in quicker. Her urgency kinda scares me, so trying to weed through how to hurry up these processes. Thank you for the help.
 
Carolinas is MDA. Your neuro is right if you do have MND then you probably should be going to a clinic not an isolated MND specialist. The insurance I used to have ( fortunately not when diagnosed) only had one MND specialist in their preferred network so people had to see him first but he always referred the ALS patients out of network to one of the clinics
 
Karla, the clinic will allow you to see all the specialists who will help you. That includes dietician, pulmonologist , pt, occupational therapist, social worker, etc. if you just see a neurologist, you won't get the benefit of these necessary people all in one place. Most clinics schedule appointments with all these in one day so you don't have to keep returning. A tiring day, yes, but better than six appointments!
 
Thank you very much for the information.
 
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