International ME/CFS and FM Awareness Day Is On May 12, 2018
Thomas Hennessy, Jr., selected May 12th to be our international awareness day back in 1992. He knew that May 12th had also been the birthday of Florence Nightingale. She was the English army nurse who helped to found the Red Cross as well as the first school of nursing in the world.
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Dr.Chia ...are there was to get your insurance to cover?

Discussion in 'ME/CFS Doctors' started by Nessajean74, Jun 10, 2018.

  1. Nessajean74

    Nessajean74

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    Hi
    I looked at the insurances he takes...and he does take Medicaid which I do have. I am in California...but my Medicaid is IEHP in San Bernardino County. Does anybody know if we can get our insurance to cover a Doctor in a different County??? His office is less than 2 hours away from me...I would love his help...my Rheumatologist is smart and nice but does not know enough about ME/CFS or EBV.
    Any help would be appreciated...TIA
     
    alkt likes this.
  2. Diwi9

    Diwi9 Administrator

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    I don't know about insurance, but his rate is very cheap in comparison to any other ME/CFS specialist in case your insurance will not cover (but I hope it does!).
     
    Patrick*, alkt and Nessajean74 like this.
  3. Nessajean74

    Nessajean74

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    Thank you
     
  4. Mary

    Mary Moderator

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    I think you would have to ask IEHP if they would cover Dr. Chia. I just looked up IEHP and it appears to be an HMO and generally with HMOs you have to stick with the doctors on their list.

    If they won't cover Dr. Chia, is it possible to dis-enroll from IEHP and just go with straight Medicaid?

    I'm on straight Medicare - no Medicare Advantage (HMO) plan - and Dr. Chia accepted straight Medicare, but he would not take a Medicare HMO plan.
     
    Nessajean74 likes this.
  5. Nessajean74

    Nessajean74

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    When I first started u was on straight Medicaid then they made me choose. I will be calling tomorrow to see if they have other options for me or if I can go back on straight Medicaid. I can also do Kaiser vit dont recall if he takes Kaiser. I have been in SSI for many years so I will call them as well to see if I get can get Medicare. Thank you for your reply
     
  6. Mary

    Mary Moderator

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    Who made you choose? I don't think a county can require that someone enroll in a Medi-Cal HMO program. It's an option to enroll but I don't think they can make you do it.
     
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  7. Nessajean74

    Nessajean74

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    I dont recall...but they mailed me info on all the choices...I think they choose for you if you dont. It was many years ago
     
  8. Mary

    Mary Moderator

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    Okay, well, it certainly would be worth looking into. If Dr. Chia does take Medicaid, he probably only takes straight Medicaid, though it would be good to call his office find out for sure.

    And if you can get straight Medicare, that would be great. A lot of doctors take that. But I have not found any doctor who I want to see who will take a Medicare HMO.
     
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  9. JinZ

    JinZ

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    I'm on Anthem :) (it covers Dr. Chia but I had to switch to their network in torrance IPA)
     
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  10. Webdog

    Webdog Senior Member

    Kaiser Permanente has no ME/CFS specialist in-network (I have this in writing), and apparently automatically denies out-of-network specialist referrals as policy. The only way to get an outside referral for ME/CFS specialist care from Kaiser Permanente is (California only):
    1. File a complaint with Kaiser Member Services for out-of-network ME/CFS specialist care.
    2. Get denied (I've never heard of an approval).
    3. File an Independent Medical Review (IMR) complaint with the California Department of Managed Healthcare. An IMR approval will override Kaiser Permanente's denial for ME/CFS specialist care.
      https://www.dmhc.ca.gov/FileaComplaint/SubmitanIndependentMedicalReviewComplaintForm.aspx
    The process takes a couple months and some effort, but there is a good chance for success. 69% of all IMRs are approved.

    The California Department of Managed Healthcare regulates all HMOs in CA, including Kaiser Permanente.

    My hope is that if enough IMRs are filed, Kaiser Permanente will consider hiring an ME/CFS specialist in-network. But I suspect we are still a couple years away from that.
     
    For├že e Honra likes this.
  11. JinZ

    JinZ

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    Kaiser amazing ratings tho!
     
    Last edited: Jun 13, 2018
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  12. lindaso1

    lindaso1

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    @JinZ
    Re: The appeal process for Kaiser. Do you know of anyone successful in getting Kaiser to pay for one of the well known out of county ME/CFS doctors such as Chia or Kaufman or do they try to refer you a local doctor?
     
  13. JinZ

    JinZ

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    I don't, I had to switch to Anthem and then change into Torrance IPA to get an appointment with Dr. Chia. It's a painful process.

    I went through everything with Kaiser and they just kept tackling the checklist. I was on track to do a sleep study but that's when I had enough and left for another provider. Fortunately I had the options to go outside of Kaiser so I didn't have to refer out. I have no information on the process to refer out but I assume you would have to go through at least a portion of their checklist prior.
     
  14. lindaso1

    lindaso1

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    Just to update. I called Dr. Chia's office & they are booking for Sept of 2019. They said they hope to see patients sooner with some changes they are making in the office but he is currently booking a year out.
     
  15. JinZ

    JinZ

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    Their wait-list process is, they call you and if you don't pick up they call the next person. No voice message. I got call for September 2018 appointment but I didn't pick up :eek:
     
    lindaso1 likes this.

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