My son has aplasia cutis congenita. Basically, that means he had some skin missing from the top of his head when he was born. They said when he was about 9, they'd do surgery to cut out the scar tissue that has since covered the "holes in his head" and cinch up the skin to leave much much smaller scars. Right now, one is about the size of a pencil eraser and the other is the size of a nickel. They said that if he got teased at school, we could do it earlier.
He's now 7, and just skipped 1st grade. He has made friends at school and in his new class, but social skills lag behind his brains, so he does NOT need anything else to get teased about, if you know what I mean. When I went to see him in the 3rd grade spelling bee, I was sitting in the back and saw older kids pointing at his scars and laughing silently, then tapping on their friends shoulders so they could laugh at him, too.
And my son is finally on board with getting them removed, too. Before, he really liked them, which attests to our laid-back attitude about them. Dad used to say they both had bald spots, lol.
We were thinking we'd like to do it during Spring Break in a few weeks. But the 3 of the 4 surgeons the pediatrician recommended said they don't do that kind of surgery, and the 4th is a plastic surgeon who, our ped warned, is used to charging as much as he wants. On top of that, he doesn't take our insurance at all.
Everyone we talked to today told us to call this plastic surgeon, that he's the only one who would do it. Earlier, we visited a dermatologist who also said he couldn't do it, and referred us to this plastic surgeon.
I called our insurance company, and they didn't find any pediatric plastic surgeons in Idaho OR Utah! This doesn't seem like that complicated of a procedure, so I'm quite surprised.
Has anyone else had a hard time finding a doctor to do a procedure? Are there any avenues I haven't explored yet?
This is why I ask you ladies! Thanks for all the ideas!
When I asked my insurance company about it, they said that they could bill it as an in-network procedure, up to the allowable amount (for example, $200). That means they'd pay 80% of the $200. But if the doctor charged $500, they would still only pay 80% of the $200, and we'd pay $340. Which is better than nothing.
Susan, my parents and sister live in Napoleon, which is near K.C.! If we needed to, I think we actually would travel there, because of family.
I looked up our local "children's hospital" which is really just a wing. They do not list any dermatologists or surgeons on their website, but I plan on calling them as soon as they're open again. I will also be calling Primary Children's Hospital, which is a very big, well-respected hospital in Salt Lake City (only 5 hours from us).
Thank you so much for your ideas!
I would contact a children's hospital and tell them about it. They know which doctors will have a heart for kids.
I can't give you an answer, but I just wanted to let you know that my heart goes out to you. Kids can be mean, and it's hard watching your child be teased. I second the advice to contact a children's hospital (we live in Atlanta and love Children's Healthcare of Atlanta! Not sure if you'd want to travel that far, though.) I did find this, but it's in California:
http://www.freshstart.org/default.aspx
I would talk to your insurance company and see how they are able to help you. An outspoken parent that advocates for their child to the insurance company (and who talks to the right people!) can really get insurance to do and cover more than they're willing to tell you on that first phone call. Let them know you're not going away and WILL find a way for them to get your son the surgery he needs! Best of luck!
I would talk to your insurance company again. Since there aren't any pediatric plastic surgeons in either state I wonder if they could work something out with the one that will the procedure ?
I dont know how far you are willing to travel or if it is covered under you insurance....we have 3 sons who were all 3 born with bilateral cleft lips and palates. our oldest also had a type of birthmark on his head about the size of a dime. our sons surgeon is a plastic surgeon and he removed the birthmark off of his head during his palate reapair and the scar is very small. His name is Dr. Singhal, he honestly is the BEST. he actually loves what he does, he loves the kids and genuinely wants to help and heal. he travels all over the world about 4 times a year doing surgeries for children who dont have medical care or the money to pay for it. We live near Kansas City, Missouri. I know it is far from you. He is at Childrens Mercy Hospital and the phone number to the clinic is ###-###-####. Good luck!!!
Hi,
Maybe check into childrens hospital~seattle wa.. I know they have places where out of town families may stay while the child is being treated.. our friends stayed at the ronald mcdonald house.
I work for a plastic surgeon in Montana who is the only doctor in this area who does certain procedures. He also doesn't participate with most insurance companies, so I'm somewhat familiar with this situation.
My suggestions are to contact your insurance company to see if they have an appeal process for getting coverage for the procedure by the plastic surgeon because there is no one else in the area who can do it. Some insurance companies will make exceptions under those circumstances if you jump through all the hoops they require for the process.
Otherwise, I would contact the plastic surgeon's office, explain your situation and see if they would be willing to offer the service at a discount and/or make payment arrangements with you that you could afford.
Good luck!
I used to work for an insurance company. I'm glad you talked to them about paying this doctor as an in network procedure. I just have a couple of other pieces of advice. If you didn't do it already, make sure you have either an approval number or the customer service rep's name, time & date you called, and what you were told about the in network payment. Despite the insurance company's best efforts and intentions, the reality is that these types of exceptions are tough to track once the claim comes in. Chances are, it will be paid incorrectly the first time. Don't freak out. Expect it and call them with the approval number or the cust svc call information and ask them to reprocess it correctly.
My second piece of advice is to talk to the doctor and/or his office before the procedure and explain your situation. Tell them that they are the only place that does it & that could mean you will end up with a larger bill and see if there is anything they would be willing do to for you. You would be amazed at how many providers are willing to write off a portion of their bill or bill you less if you just talk to them first. It doesn't hurt to ask.
Good luck with everything!
