1. Patients launch $1.27 million crowdfunding campaign for ME/CFS gut microbiome study.
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Hunting down the cause of ME/CFS & other challenging disorders - Lipkin in London
In a talk to patients in London on 3rd September, Dr. W. Ian Lipkin described the extraordinary lengths he and his team are prepared to go to in order to track down the source of an illness, with examples ranging from autism to the strange case of Kawasaki disease.
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Looking for Covered California Obamacare advice

Discussion in 'ME/CFS Doctors' started by Mr. Cat, Jan 9, 2014.

  1. Mr. Cat

    Mr. Cat Senior Member

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    Nothern California
    Hello,

    So I don't have insurance and I am looking into Covered California (Obamacare in CA) around the SF Bay Area, and wondering if it would be helpful at all for CFS. The options are Blue Shield, Anthem Blue Cross, and Kaiser. I had Kaiser before and it was not helpful. Anthem is the only one that has a PPO. I called Anthem to see if they had any CFS doctors. The sales associate was unable to find me one, probably because it isn't one of their listed specialties. He also told me that if CFS wasn't a condition covered in my contract, treatment for it it wouldn't be covered by the plan. When I asked if CFS was a covered condition, he said I would have to buy the plan first and look at the contract, but that he couldn't tell me before I had bought the plan. I had him repeat this a couple of times to see if I heard it right, and it sounds like I did. Wow. I have not contacted Blue Shield yet. With a PPO, I might be able to go out of network to a specialist, but if CFS was not covered in the contract, this would conveniently protect them from having to pay.

    So anyway, this is my first foray into the insurance fray. Is anyone else considering trying to sign up for Obamacare to address CFS issues with these insurances? Any advice on getting PPOs to pay for a CFS diagnosis from a specialist out of network?

    Thanks
     
    SanDiego#1 likes this.
  2. SanDiego#1

    SanDiego#1 SanDiego#1

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  3. Ayaju

    Ayaju *****

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    San Diego, CA
    Wow, not much has changed for us yet.

    I have a PPO through BlueCross/BlueShield for Federal Employees, and it is considered one of the best. But even they don't know jack about CFS. I have been searching for 16 years to find a local CFS doctor in network; I'm still searching; I've been through so many doctors.

    If I call the insurance co. and ask them to help me find a CFS doctor, they have zero information about that. It's all been trial and error for me. I have had to make appointments with doctors in order to inquire; calling their office doesn't help, as the people who answer the calls don't know what CFS is, and can't tell me if the doctor does either.

    If I were to advice you, I'd suggest getting the PPO; for the freedom and the options. All you would have to do if you found a doctor who cared and who was teachable, is to request not to list in your records "CFS" if it's not covered. The doctor can list the symptoms instead.

    Good luck!

    Judy
     
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  4. SanDiego#1

    SanDiego#1 SanDiego#1

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    i HAVE FEDERAL BLUE CROSS BLUE SHIELD IN GEORGIA PPO-THEY HAVE PAID WELL ON MY
    CFS. I THINK IT DEPENDS ON THE CODES YOUR PHYSICIAN PUTS IN. AS CFS COVERS MANY AILMENTS.
    DON'T KNOW ABOUT THE REG BLUE CROSS-BLUE SHIELD.
    ALSO A LOT OF THE CFS DR. DON'T TAKE INSURANCE AT ALL.

    BEST
    SAN DIEGO #1
     
    Mr. Cat likes this.
  5. SanDiego#1

    SanDiego#1 SanDiego#1

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    I NEVER, NEVER, ASK FOR A CFS DR. I GO TO INFECTIOUS DISEASE, OR ENVIRONMENTAL. OR NEUROLOGIST.

    SAN DIEGO #1
     
    Valentijn and Mr. Cat like this.
  6. ggingues

    ggingues $10 gift code at iHerb GAS343 of $40

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    Concord, NH
    My good Dr is internal medicine. FYI And I think that is one of the common practioners.

    Not much on the Co-cure list: http://www.co-cure.org/USA_CA.htm only 2 in San Diego, perhaps you are close to another listing? The list is quite outdated, but my Dr was on there.

    Sounds like you would have to get a list of the Drs, find them on the web, and see what they say on their websites.

    Surprised a huge state like CA does not have some org that could help you find a Dr?!

    I live right next to a state that offers that: http://www.masscfids.org/services

    We can:

    • Assist with patient referrals to healthcare providers
    • Give guidance on disability process and issues—please see the Disability Handbook available on our website
    • Provide information about active support groups or other sources of support
    • Respond to general questions about these illnesses.
    To obtain services, please fill out the Contact Us form or call our Information Line (617) 471-5559.

    GG
     
    Mr. Cat likes this.
  7. minkeygirl

    minkeygirl Narcissism = lack of self awareness

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    Left Coast
    I wouldn't specifically look for a CFS doc since there could be some other specialty that you end up seeing. I wouldn't waste time asking the insurance people. My insurance people wanted to send me to a physiatrist for my ME.

    You need to find a doctor THEN find out what insurance they take. IMO the best would be to get a PPO. There are probably zero good docs that are in an HMO because they are hamstrung but time constraints and what they can treat and could get in trouble for using "alternative" methods.

    So I would find the doc first, then look for the insurance.
     
    Mr. Cat likes this.
  8. ggingues

    ggingues $10 gift code at iHerb GAS343 of $40

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    I had a physiatrist prescribe me my meds for sleep, and they have been working for over 4 years now with only a slight increase in dosage! Another physiatrist I saw is really great at giving me trigger point injections, they provide me with a lot of relief from muscle tension/spasms etc..

    GG

    PS Physiatrist are physical medicine Drs, not psychiatrists, perhaps you had a misspelling?

    http://www.medterms.com/script/main/art.asp?articlekey=4890

    Physiatrist: A physician who specializes in physical medicine and rehabilitation. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, or nervous system, such asstroke victims.
     
  9. minkeygirl

    minkeygirl Narcissism = lack of self awareness

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    No misspell. I have very little pain and u don't need rehab. It would be like seeing an allergist for a broken arm for me.
     
  10. ggingues

    ggingues $10 gift code at iHerb GAS343 of $40

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    Concord, NH
    Like I said, they don't all only treat pain. Mine prescribed me meds until he found something to help with my sleep!

    GG

    PS And some people/Drs think sleep is the most important component, since if you do not get "good" rest, how can your body heal?
     
  11. minkeygirl

    minkeygirl Narcissism = lack of self awareness

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    I have another doc helping with sleep so for me as I said, it was ludicrous to send me to a doctor for orthopedic issues. That was from some idiot at an HMO who had no clue.
     
  12. madietodd

    madietodd Senior Member

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    East Coast, USA
    I went with a BCBS PPO silver plan, because ONLY the silver plans get all of the government subsidies. So watch out for that. I agree with the coding comments - once you find a good doctor, they can code to get you coverage for whatever specific thing they end up treating. OI, hormonal imbalance, insomnia, whatever.

    Insurance companies can't help you find a good doctor. They're just sitting at computers looking at lists of names and addresses, just like we do. I have a local doctor who lists CFS as one of his specialties on his website, but he (a) doesn't keep up with research at all, he just follows Dr. Teitelbaum's checklist, and (b) I have to pay out of pocket and get reimbursed. So I'm still looking for a doctor who's smart and curious who takes insurance. I think a group practice is a better bet than an individual supporting an office alone.

    I picked BCBS because none of the other plans were country-wide, and I see Dr. Rey in Florida to get the advanced testing.
     
  13. IreneF

    IreneF Senior Member

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    Try contacting Covered California directly. It seems really shady for the agent to refuse to tell you what's covered before you buy the plan. I've also read that many doctors won't accept patients from some plans because the reimbursement rates are too low.

    In the Bay Area you can try Dr. Montoya at Stanford or Dr. Kogelnik in Mountain View. I don't know if they are taking new patients, but Kogelnik got a partner last summer.
     
  14. madietodd

    madietodd Senior Member

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    In Maryland they're called "navigators." They don't get copies of the policies either; they only know the information anybody can get on the state website. I signed up in early December and still haven't gotten any plan details.

    You can call the sales department of the insurance company you're looking into; they'll have more information. But you have to have your specific list of questions handy - they're also just at computers, looking up files.
     
  15. SanDiego#1

    SanDiego#1 SanDiego#1

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    On the sleep issues- I have found after asking my Dr. to see a Sleep Specialist and using a CPAP sleep machine-
    My sleep issues and Palpitations are almost completely gone. Have to see someone that knows what they are doing and how to adjust the pressure. It has made all the difference in me. I use it 7-8 hours to be effective. Energy level is up and this has been now getting better and better for 6 mo. Even when I overdo-I recover quicker.If you are not doing well on one-you may have the wrong pressure setting and not enough humidity.

    San Diego#1
     

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