Friday, January 15, 2010

small success

I love our pediatrician. First off let me say that we are Kaiser people. We are Kaiser people because this was the lowest cost option to me when I got my first real job out here in Ca in September of 2001. So, even when I left that job after I had Avery, we stayed with Kaiser because, well, they suck you in and they are somewhat cheap. Everything is all connected. My primary can go in to the computer and see all my visits with all my Dr's (I dont have THAT many I swear). If I need a prescription, I pick it up in one building over from my appt THAT day (an I do need several!). I can email my Dr's-actually any Dr. that I have ever seen or has ever seen my children. Its all so connected that I feel if we ever left I would be lost at sea-I dont know how to do real insurance!

anyway...Kaiser is a ginormous HMO. Which means that is pretty easy-when there is nothing wrong. the moment something comes up thats off the normal path and the hoops get lined up for you to jump through one by one very slowly. And it becomes a pain in the ass.

Well a problem did come up, as you know. Avery got diagnosed with Rett syndrome. So we need some more help. That help comes in the form of Katie's Clinic for Rett syndrome at Children's Hospital in Oakland (20 minutes away!) This is the same clinic that our old neurologist failed to mention to us when I specifically asked if there were any specialists in the area! oops.

So I call the new neuro's office and ask if they will give me a referral to the clinic. Nope, not until the new Dr sees Avery and even then it isnt "needed". So I ask my ped and she says "wait to see Dr. M (new neuro) first. Let him tell you what Kaiser has to offer and then see if you still want the referral". Umm, hmmm. Let's see. Avery has Rett syndrome. The clinic at CHO has super sonic specialists that KNOW Rett syndrome. Not needed? I beg to differ. I mean the flu shot isn;t really NEEDED is it, but guess who wants you to rush in a getit? KAISER! So I get into an email exchange with my ped. She tells me she never said it wasnt needed and that if after we see Dr. M, and he doesnt refer, she will! So I let her know that regardless of what Kaiser offers Im still going to want to go to the clinic and oh by the way we have an appt on the 12th of Feb! She calls me and leaves me a message saying she put the referral in!

Thats the first hoop. Now we wait to see if the powers that be approve this referral. It's $1500 bucks. Not a lot to a gigantic HMO that, by the way gets about 8-10K out of just our family yearly. And it will be so helpful for us! We have lots of questions! This is our baby!

So, like I said, I love our pediatrician. She made it happen.
I'll keep you posted on hoop #2.