We have been referred to a pediatric gastroenterologist by our pediatrician back in September, for Little M. He has been vomiting since July and we can't get it in control using Zantac. The problem was, there is only 2 specialist near us. The first one cannot be reached by phone. The other is Albany Medical Center, who do not accept Aetna. Albany Med's procedure is to wait for the medical records to arrive in their office and then they call the patient for an appointment. A month of waiting to be called, I finally called them to check and see if they took a month to call back. I was told that they usually call within 24 hours of receiving the medical records and when the person checked, Little M's record wasn't there.
The logical conclusion for me was the follow up with our pediatrician, who then told me that they did fax the records. So I asked that they please fax again because Albany Med never got it. After they promised, I waited. After a week, I called Albany Med again and again they said they never got the records.
I called our pediatrician and pleaded for someone to follow up with Albany Med after faxing the records, and someone there took pity on me and said she would do it. Later that day she called and said, Albany Med doesn't accept Aetna and that's why no one is being assigned to my son to handle the appointment-making. My next action was to call Aetna to tell them, because upon searching online, I couldn't find any pediatric gastroenterologist listed in their website. An Aetna rep told me that there wasn't one participating with them within 100 miles, but they would authorize a visit with Albany Med. I was finally happy at this point because it seemed that now I could get my child treated.
I called our pediatrician once again, and asked that they fax our records to Albany Med. The lady said, they don't accept Aetna so I should checked with Albany Med first to let them know. So I did. I talked to Albany Med and explained that we are willing to pay for treatment out of our pockets and they wouldn't have to deal with Aetna. The rep reiterated several times that if this was the route we are to take, they need money in advance. I said, yes, I will pay.
To make the story short, there were several more times when our pediatrician faxed our records, but apparently Albany Medical Center kept discarding them upon seeing the insurance name. By this time, it's already November and we're not getting anywhere. I twitted about my frustrations and Aetna social media team came to my aid. I asked them for a list of pediatric gastroenterologist even if it's far from my area, and they immediately emailed me with a list. With Daddy's help, we picked Fishkill as the place to go. It's a 100-mile drive, but at this point, I would rather make the drive then rely on Albany Medical Center. Daddy did some Google searches and found that Aetna and Albany Medical Center had a riff about 2 years ago when Albany Medical center demanded a higher rate of pay (higher fee schedule) than the national average. So their contract was severed. It's a good thing at this point that we have decided not to pursue Albany Med any longer. If all they cared about was money (which we agreed to pay in advance), then who is to say they will do their best to treat my child? If at any point they fear of our ability to pay, they may skimp on any necessary test and treatments. So good riddance.
My 2-year old vomits everyday, sometimes several times a day. He is so used to it he runs to the trash can on his own and it breaks my heart. We travel with a little bucket so we don't have to run to the nearest (sometimes very far) restroom. So yesterday, we made the 2-hr, 100-mile drive south to see a specialist. We were seen and we headed to a new treatment plan with stronger medicine and should this course of action not stop the vomiting, we will pursue more test and perhaps find possible food allergies.
It was an exhausting day for my Little M and I yesterday. Daddy had to be available for the other 3 kids, in case of any emergency that might occur. But through the exhaustion, there is elation. I am happy that we no longer have to settle for a medicine that clearly wasn't helping my boy. The doctor said just like adults, kids can be on Prevacid and or Prilosec. So we were prescribed chewable Prevacid. The doctor advised me that the insurance might not cover this medicine, so he thought we should opt for Prilosec, which is a liquid that some company in Boston mixes up and then ships to us. It must be refrigerated, but is much cheaper than Prevacid.
We are going on a family vacation to Florida next week, so I asked the doctor to go ahead and give us a prescription for Prevacid, as it is a lot easier to carry than a liquid that must be refrigerated. So after being exhausted and barely staying awake on our drive home, I went to the pharmacy and picked up our new medicine. The medicine is a solu-tab and after the insurance paid for just a bit over half, we had to pay $100 out of pocket for a 30-day supply. Daddy and I have decided this is acceptable, especially that we are traveling next week. Considering that just a little bit over a year ago, we paid over $500/month for our family's asthma medication, that $100 is acceptable. We had BCBS last time and they barely covered asthma medication. This year we have Aetna and they cover asthma medications pretty well, so the $100/monthly copay for Little M's medicine is something we can handle.
So this morning was Little M's first dose - and this is the first morning he hasn't vomited. Usually every day when we take his older siblings to the bus stop, because of the cold and the running around they do, it triggers vomiting in him. Today it didn't, and for that I am very grateful. Hopefully this is a sign that the medicine is working, though I do know it's too early to tell after only 1 dose.
Another blessing about seeing a specialist, is that I found out that the 1st line of medicine to try that our pediatrician gave us months ago, was apparently not recommended for children. Our pediatrician told us to try metoclopramide (Reglan) first to see if helps the vomiting and after 3 days, use Zantac. After using Metoclopramide, Daddy and I decided it didn't work so we started Zantac. The pediatric gastroenterologist said that Metoclopramide is known to cause neurological side effects so it is not the first medicine he prescribes for an otherwise happy healthy baby who is gaining weight well. Generalist doctors might know a lot about everything, but they are do not know much when issues are more in-depth.
So I am hopeful for my baby that he would eventually stop vomiting. If not, then at least we know that there is a course of action and that we don't need to be satisfied with treatment that was barely helping him out.
It is my hope that with this blog, I can share my experience with Albany Medical Center. When you are worried about your child's health, you don't want to rely on a facility who puts money ahead of their patients.
No comments:
Post a Comment