Insurance gurus?

[amo_mea_filiis.]

Ds was all set at the children's hospital in Delaware. Then i get a notice yesterday that access plus will be no more as of March 1st. I have to choose a managed care plan by February 7th that goes into effect March 1st.

 

I called the PA enrollment people who can't help me choose a plan. I called the welfare office, but my caseworker did not even know about this change. I called the PCP office and they couldn't help but did say they only accept one of the three choices. So then i called the member line for that company.

 

We can't figure out if ds's Drs take any of these because they're out of state, and what the customer service rep told me sounded a little too good to be true.

 

She did some research and called me back (research may just have talking to a supervisor). Since ds is already established with the speciality Drs in Delaware on access plus (he'll have 2-3 by the switch), his primary can submit prior authorization for medical necessity to continue with these Drs if they're not on the plan by the time of the switch.

 

I am going to call the children's hospital billing dept today and see if they have more info.

 

I have only looked into the one plan so far because of the primary. The primary has a severely autistic son and ds does not scare her, and she handles dd's needle fear very well. The nurses understand that ds may walk out of the room while I'm talking to the dr, and so far they're fine with him. The entire office will engage ds if he walks by them, and he doesn't seem too scared to answer them (this is big for him. He'll curse at you, but will not usually talk or answer a question). He also lets the dr examine him instead of fighting. She believes him when he says the otoscope hurts and she's very gentle but firm about everything.

 

So... Do i even look into the other 2 plans? Should i call them and see if they're as helpful as the first?

 

The paper i have about everything lists stuff mostly unimportant to me; cost of ambulance ride, gym membership, kid obesity nutrition classes, etc. None of them really tell me what i need to know.

 

I think i can eliminate the first plan based on the prescription med limit. Both kids have asthma. Ds has 2 standing meds, and dd has 3. Dd has already reached the limit so if she needs oral steroids, it could be a hassle getting around the script limit.

 

Advice? Would it be helpful if i posted the choices?

[amo_mea_filiis.]

I will call the two possible companies when we get home (therapies now). The therapists will be accepting all 3.

 

Since the companies can't even find ds's Drs, what ARE my other relevant questions? Lol.

 

I should ask if tubes can be done in office, because that would some things easier for me.

 

I know my CPAP equipment will be covered, but could be a pain.

 

I need to make sure that OT/PT/ST are still good and see if there are limits. Ds's speech needs to be increased big time.