Need parent's advice on insurance problems

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Does anybody have tips for fighting with the insurance company's excusses in order to get a doctor that knows about AS or at least comorbid conditions? I was originally planning to fight them just to get a formal AS dignosis, but I think this takes precedence. One, or possibly both of my medications seem to have stopped working and I'm having difficulty navigating the insurance company and medical group's beureaucracy. Anybody have any experience fighting them and have any tips?

Sean,

Are you dealing with an HMO, PPO, or regular insurance company.

First you need to find out if the insurance has mental health coverage. If not, you are stopped right there.

If you are dealing with an HMO or PPO then you have get a doctor who is in their network. I would request a list of all doctors in their network who specialize in AS. Of course, you also need to get approval from you primary care provider (doctor) and that can be hard unless your PCP knows about AS.

That same as above for a PPO I believe although I do not know if you need the referal or not.

If it is regular insurance, look in the insurance contract book to see what the procedures are and follow them.

It's an HMO.

OK Sean,

Your best bet then is to go to your PCP (Primary Care Doctor) and explain that:

a) The current medications that you are taking are not currenlty working

b) That you would like to verify that the initial diagnosis was correct and that AS was not missed (which is very probable in most adults). The PCP should have a list of doctor who specialize in AS that are part of your HMOs network.

Now realize that your PCP gets a bonus for not refering people to specialists so you may have to fight the PCP for the referal.

Welcome to US Healthcare.

Sean,

ljbouchard gave you good advice. My insurance company doesn't seem to like the dx of AS because you can't treat it so I attacked it from a slightly different angle. We got a refer to a specialist who treats the comobids BUT our doctor knew we wanted someone who was familiar with AS.

In other words, if we had asked for someone who works with AS patients we might have run into a wall AS as isn't treated. Instead we asked for a doctor who deals with anxiety, something they DID have, and, off the record, made it be known that we also wanted someone familiar with AS.

I'm not sure that is clear.

Its unfortunity that one was to play games to see a doctor.

BeeBee

Thanks everybody for your advice. I was finally able to get an appointment with a neuroligist. By the time I see him, I will have been completely off of one of my meds for just under a month (I quit taking it altogether to hurry up and get the withdrawls over with). Anafranil (Clomipramine) is supposed to be an antidepressant, but my moods seem to be more stable without it and I'm more happy in general. However, I'll need a way to focus, manage my time, and establish a regualr sleep schedule until then. I think I'll work on the recent decrease in inhibitions myself which will be important, as I'm (very slowly) saving up for a gun. Probably either a .357, a .44, or a Remington 870 with the intention of eventually modifying it into a full combat shotgun.