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Novice
Picture of OnnaBugeisha
posted
Okay, I know there are many threads on Jefferson already, but I didn't see one that specifically answered my question (but maybe I missed it in the search). Do you HAVE to go through your doctor to go here or can you try to get an appointment here on your own? I am fed up with my neuro and I know it will take me forever and a day to get in here and I think I want to get the ball rolling if I can do this thing on my own. Thumbs Up

I guess I should start looking into whether they will accept my bluecross blueshield insurance as well... any advice any of you have to offer me would be MUCH appreciated. It sounds like I have a long road ahead of me to even get in here. The good news is I am really close to Philly and I am only about 50 minutes away and I can easily drive or take the train and get off at Market East too. Big Grin


~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~

Defeat may test you; it need not stop you. If at first you don't succeed, try another way. For every obstacle there is a solution. Nothing in the world can take the place of persistence. The greatest mistake is giving up.
 
Posts: 99 | Location: Delaware | Registered: 12-12-2011Report This Post
Apprentice
Picture of andrea316
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If I remember correctly, I called them when considering an appointment with them for Bennett, and you can schedule on your own. Also consider asking them to put you on a call list for any cancellations.

They should also be able to tell you which insurances they accept when you call. Heck, you don't lose anything by calling!

Good luck!
Andrea
 
Posts: 167 | Registered: 05-18-2011Report This Post
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Picture of dragondroolHOST
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I hope you've found an answer to this. I'm sorry I can't offer it or give advice, as I've never been there. Montana isn't very close.



Dragondrool
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Posts: 6478 | Location: Montana | Registered: 01-11-2007Report This Post
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Picture of Teri Robert
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I called and made my own appointment. I had to have a referral for insurance purposes, but not to get an appointment from the clinic's point of view.



Teri Robert
Lead Health Guide, HealthCentral Migraine Community
terimmc@helpforheadaches.com

Author of Living Well with Migraine Disease and Headaches

Stay up-to-date on Migraine info with my free weekly newsleter. Subscribe here

visit me on or

 
Posts: 4220 | Location: West Virginia | Registered: 01-11-2007Report This Post
Grasshopper
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Teri is correct.

Unless specifically required as part of the doctor's policy, most physicians allow you to self refer for an appointment. However insurance companies polices usually don't allow self referral. The insurance may or may not pay based on a self referral basis.
 
Posts: 28 | Registered: 07-27-2009Report This Post
Novice
Picture of OnnaBugeisha
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After some thought and feedback on the ENT question, I called Jefferson. I didn't even get an actual person on the phone. Thumbs Down All they have is an answering machine where you leave your name and number and they basically say they will get back to you sometime before dooms day. Head Banging Here's to hoping it will work out. I called my insurance company and it looks like they will cover it, so my copay will just be my usual specialist copay, which is great! If they ever call me back, I will have to confirm that, otherwise I will have to cover the bill up front and have to do some financial shuffling... which honestly, I don't know if we can afford right now. We will have to sit down and figure it out. I imagine they won't be able to get me in for 5-6 months or so, so that would give us plenty of time to figure it out though. In the meantime, my phone will stay glued to my side so I can answer the call in case they DO call me back. Knowing my luck, they will call as soon as I walk away!!!

I guess my biggest hangup with going to something like Jefferson is that I feel like my problem isn't severe enough to go to something so grand. There are so many people out there so much worse than I am. Embarrassed I just feel like they will think I am silly going there... like I have only gone to one quack neuro and one quack doctor...


~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~

Defeat may test you; it need not stop you. If at first you don't succeed, try another way. For every obstacle there is a solution. Nothing in the world can take the place of persistence. The greatest mistake is giving up.
 
Posts: 99 | Location: Delaware | Registered: 12-12-2011Report This Post
<Nancy Harris Bonk>
posted
Wait a minute, what do you mean your problem isn't "severe" enough? If you have Migraine pain that is limiting your quality of life, that is serious enough. As hard as it may be, try not to compare your life to others. Yes, someone is probably much worse off than you, and then there are others who aren't as "bad" as you ( you know what I mean) but that doesn't mean you don't have the right to get the best treatment you can. I don't mean to sound preachy here and I highly doubt they will think you are silly, but hey, you deserve it!

How many Migraines are you having a month? Too many I bet Yes
 
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Master
Picture of JennyHOST
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Onna,

I am currently a patient at Jefferson, so I can share experiences with you:

First, getting that initial appointment is the hardest part at Jefferson. It may take a while before they call back. Be persistent and call again if you do not hear back. Once you are an established patient, it is easy to get a receptionist/nurse/NP to address your patient needs. Just get your foot in the door and you will receive terrific care!

Second, Jefferson is a terrific Headache Center, and all sorts of patients are seen there. I've met folks who have a few migraines a month, and others who are in constant, severe pain. If your migraines are interfering significantly with your quality of life, it is certainly appropriate for you to consult with a specialist. And Jefferson is just the place to get great care!

Please let me know if you have any Jefferson questions...


JennyC
Forum Moderator
 
Posts: 354 | Location: PA | Registered: 04-02-2011Report This Post
Novice
Picture of OnnaBugeisha
posted Hide Post
Nancy, to answer your question, I have about 12 headache days a month on average, with about 6-8 of those as what I consider to be migraines. That total is taking out what I consider insignificant headaches that I hardly notice anymore. Before I went on Topamax, I was having 17-23 headache days a month with ~10 migraines a month. My current/in the proccess of being fired neuro is treating all of my headaches like migraines and says that I have chronic migraines that are in the process of becoming daily dull headaches....

He refuses to let me try any other abortive medication other than imitrex (which doesn't work) other than to say "Try naproxen". Really!?! All you have to offer me is Aleve!?! ::sigh::


Jenny, how long do you think I should wait before I call back and leave my answer on the machine again? I hate not being able to talk to a real person. Mad Today is only the second day, so I can't really fault them because I know they are probably flooded with calls. I just hate that they basically tell you "Carry your phone with you between 8-4 every day until Dooms Day, because if you miss our call you are screwed!"


~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~

Defeat may test you; it need not stop you. If at first you don't succeed, try another way. For every obstacle there is a solution. Nothing in the world can take the place of persistence. The greatest mistake is giving up.
 
Posts: 99 | Location: Delaware | Registered: 12-12-2011Report This Post
Novice
Picture of OnnaBugeisha
posted Hide Post
Okay, so I heard back from the receptionist today. I am both excited and.... bummed. I booked the appointment (April 7th at 7 a.m. with what I thought she said Silverstein, but I am now assuming is Silberstein since I found no mention of a resident or fellow neuro with Silverstein on their site.) The part about the appointment that makes me sad is that they quoted me at $415 plus a $25 copay!!! When I inquired about the price and told her that I spoke with BCBS already and was told that they were in my preferred network, she told me that they only cover the neuro portion and that is the $25 copay, but I still have to pay the $415 at the appointment for the nurse consult and the psych eval. I mean, I knew those were a part of the appointment, but seriously? How can those cost $415!?! She told me that I can fight my insurance AFTER the fact for reimbursement, but she said that I may get all, part or none at all back. Thumbs Down

I am keeping the appointment for now since it is so far out and it will give me plenty of time to mull it over and figure things out, but I am thinking that I may have to cancel. Right now I am working two jobs and am working 50-60 hours a week and my husband is facing unemployment at the beginning of the year unless things change at his workplace. I am SO discouraged because I thought that things might finally be working out, especially when I originally called my insurance and they told me that Jefferson was in my network.... I didn't know that the psych consult and nurse charged privately and didn't bill your insurance. ::sigh:: Any tips or advice?? Crying


~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~

Defeat may test you; it need not stop you. If at first you don't succeed, try another way. For every obstacle there is a solution. Nothing in the world can take the place of persistence. The greatest mistake is giving up.
 
Posts: 99 | Location: Delaware | Registered: 12-12-2011Report This Post
<Nancy Harris Bonk>
posted
Double edged sword, I know.

Can you cut some extreme corners? You may feel like you've cut every corner already, but how about writing down everything you spend a month, I mean everything, and see where each penny goes. I've done this and it was amazing to see the waste, places I never thought of, that they didn't really add up. Boy was I wrong.

Maybe between now and then you could save up with some drastic short term changes? I know with the holidays looming and possible unemployment that doesn't sound possible...but your health is so important.
 
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Picture of dragondroolHOST
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Just because they bill separately, and don't submit to your insurance doesn't necessarily mean that it won't be covered. It might just be that you need to submit it yourself. I used to go to a naturopath that didn't submit billing, and all I had to do was submit a copy of the paid receipt as a claim myself and it was covered just fine. You might ask your insurance company what their procedure is for this.



Dragondrool
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Posts: 6478 | Location: Montana | Registered: 01-11-2007Report This Post
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Picture of JamieHOST
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like droolie said, you never know until you try.

If at first they won't take the claim, an appeal can be filed, with a letter---perhaps even on jefferson stationery that those items are part of a new patient appointment.

Also, i don't know if you can split the visit over 2 days... but if you can, it's not billing for multiple providers on the same day. Yes I've been told by billing specialists that sometimes this can get around the insurance automatic filters that this trips, and kicks the claim out of the system or creates auto denials.

Nancy's right. I've had to watch every penny this month... i found a few small things i do aren;t necessary. By charting it, I found close to $8.00 that were totally unnecessary, and another 4 that were things I could have cut out. And that was being generous with myself. With couponing, I could have done even better...

Just saying... you'll find a way to make it work. Just be glad that you got an appt. with one of the top specialists in the world!


Jamie
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Posts: 2886 | Location: north carolina | Registered: 01-12-2007Report This Post
MMC Lead Expert
Supreme Guru
Picture of Teri Robert
posted Hide Post
My insurance reimbursed me for the portion they would have paid on the psych part if it had been billed to them. It's not only an appointment with a psychologist or psychiatrist, but also some testing (a slew of written questions to answer).

Quite sincerely, I think every Migraineur should have that kind of psych evaluation - It has two purposes:
1) To determine if we also have major depressive disorder and, if we do, that we're receiving appropriate treatment.
2) To assess our coping skills for living with this disease and help us develop them if need be.

I went into my first visit with quite a chip on my shoulder about the psych portion, but an now very convinced it's such a good thing we should all have it.

quote:
Originally posted by OnnaBugeisha:
Okay, so I heard back from the receptionist today. I am both excited and.... bummed. I booked the appointment (April 7th at 7 a.m. with what I thought she said Silverstein, but I am now assuming is Silberstein since I found no mention of a resident or fellow neuro with Silverstein on their site.) The part about the appointment that makes me sad is that they quoted me at $415 plus a $25 copay!!! When I inquired about the price and told her that I spoke with BCBS already and was told that they were in my preferred network, she told me that they only cover the neuro portion and that is the $25 copay, but I still have to pay the $415 at the appointment for the nurse consult and the psych eval. I mean, I knew those were a part of the appointment, but seriously? How can those cost $415!?! She told me that I can fight my insurance AFTER the fact for reimbursement, but she said that I may get all, part or none at all back. Thumbs Down

I am keeping the appointment for now since it is so far out and it will give me plenty of time to mull it over and figure things out, but I am thinking that I may have to cancel. Right now I am working two jobs and am working 50-60 hours a week and my husband is facing unemployment at the beginning of the year unless things change at his workplace. I am SO discouraged because I thought that things might finally be working out, especially when I originally called my insurance and they told me that Jefferson was in my network.... I didn't know that the psych consult and nurse charged privately and didn't bill your insurance. ::sigh:: Any tips or advice?? Crying



Teri Robert
Lead Health Guide, HealthCentral Migraine Community
terimmc@helpforheadaches.com

Author of Living Well with Migraine Disease and Headaches

Stay up-to-date on Migraine info with my free weekly newsleter. Subscribe here

visit me on or

 
Posts: 4220 | Location: West Virginia | Registered: 01-11-2007Report This Post
Master
Picture of JennyHOST
posted Hide Post
Onna,

I'm glad you have an appointment set!

A few thoughts about the first visit and the psych eval. Like Teri, I was a bit annoyed with the idea of seeing a psychiatrist. I was irritated by the testing I had to complete--it's a long inventory with lots of questions (some of which are quite ridiculous), but it's a great tool for the psychiatrist! The psychiatrist and my HA (headache) doc both explained that it's an essential part of an initial evaluation.

The doctors at Jefferson have to determine if the new patients (many of whom are in severe, chronic pain) have the necessary coping skills to continue putting one foot in front of the other. Folks who are severely depressed or exceptionally anxious will need to have those needs addressed for their HA/migraine treatment to be as effective as possible.

My HA doc also explained that the psych eval helps him to determine whether certain classes of meds are appropriate for certain patients. (For example, my doc explained that he avoids certain meds that have a depressive/sedating side-effect when the psych eval indicates that a person is struggling with depression.)

Personally, my psychiatric testing showed that I was quite anxious. After consulting with the psychiatrist, my HA doc recognized that I needed a sedating abortive medication for times when my migraine ran completely out of control. Without the sedative, my anxiety made the migraine pain 5000x worse. With the sedative, I was able to relax and sleep so the migraine could run its course and the pain could recede.

If a new patient is found to be struggling with a mental health issue, the psychiatrist sometimes makes himself available to see that patient on an ongoing basis. I believe those psychiatrist sessions are typically scheduled for patients at the same time as their follow-up HA visits, so they need to only make one trip to Jefferson to see both professionals. Keep in mind that the ongoing stuff is only as needed--patients only go that route if it's appropriate.

I paid the $$$ for the initial visit, and my insurance later reimbursed a portion. Unfortunately, it turned out to be a pricey visit for me! But in the long run, it was $$ well spent. I have great confidence in the folks at Jefferson. They don't give up! And they don't run out of ideas for treatment, either.


JennyC
Forum Moderator
 
Posts: 354 | Location: PA | Registered: 04-02-2011Report This Post
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