United Brachial Plexus Network, Inc.

My daughter was seen by Dr. Nath in Newark NJ and he suggested she should have the triangle tilt done. I called my insurance to see how much they would pay and since he is out of network they only willing to pay 5,000 for the surgery and I would be responsible for thr rest. Did anyone else bhave a similar problem and if so what did u do?

Thanks

I had to write a letter practically begging our insurance to pay and they settled upon a price with Dr Nath's office. This is something that they "don't usually do", negotiating with a doctors office, but my letter worked!! Good luck, it took about 15 months for us to get everything worked out, but it has gotten done and we are happy with surgery results.

You may have done this already, but if not, it might be worth a try. Get a letter from Dr. Nath stating the reason & necessity for surgery and also one from your primary care physician referring your daughter to see Dr. Nath and stress that he (Dr. Nath) is a specialist in this field and the only doctor who does this particular surgery. Keep talking to the insurance company and go all the way up to management if you have to in order to get some results and ask the insurance what documentation you need to get this approved. Document & date every phone call and every person you speak with, but keep working up the management chain. Good Luck!

Donna

I know insurance makes you want bang your head into a wall and I have two them (luckily).

For us, we had the Nath office do some of the leg work for calling and negotiating/precert. In addition, talk to your human resource/insurance person @your company and have them consider Dr. Nath an in network provider due the specialty of the surgery and if there is not any MD in your area the insurance may consider him and in network MD.

For us, my primary insurance has no hospitals in network or in it's whole hospital system to refer me to so Consider him as an in network MD and are paying him the usual/customary payment.

So if they will only pay him 5000.00. How much will that leave you to pay? If I may ask?

Antoinette mother of Matthew 5year old with obbp left arm

Frankie had surgrey 2yrs ago with Dr Nath we had AETNA and he was out of net work they said if we could prove there was no doctor in network that did the surgery they would cover it and of course there wasn't Dr Naths office and our peditrian sent all the required info and Dr Naths office did most of the work I didn't even need to send a letter so call your insurance co ask them what you need and tell Dr Naths office they should handle it they even got a letter of gaunteed payment before the surgery from the insurance co so they couldn't change there mind after surgery. Mare

Whether or not Dr. Nath will accept your insurance's in-network payment amount seems to depend. On what, I'm not sure. I know people who haven't had to pay anything after insurance, and others who had to pay the entire billed amount which is far-and-beyond insurance reimbursement rates. It also seems to depend on whether or not you are involved in a lawsuit. Most doctors retain the right to be fully reimbursed for their full rate from any lawsuit award.

Kate

With Frankie Dr Nath would not accept what the network doctors would he wanted his full amount what did help was the hospital Herman Memerioal was in network and since AETNA could not find a doctor in network to do the surgery they paid his rate. We were not involved in a law suit he just said he didn't accept less then his normal fee and that is why he had the insurance co sign a letter of garanteed payment so if they backed out he could sue them and I was not responsible. Have you spoken with his office manager yet it used to be shelia.

We have not yet seen Dr. Nath, but my son was a patient of Dr. Shenaq's before he passed away. He had his mod quad done at TCH before they brachial plexus clinic closed down. Anyway, what I am getting at, is our insurance covered everything 100% simply because we had a letter from Dr. Shenaq's office, a letter from my son's primary care physician and his OT. It only took us about 3 or 4 months to get all of the approval.

Good Luck!

We have BCBS...they were willing to cover a teeny, tiny percentage (basically nothing) Reason? They said that other surgeons (in Network)all over the U.S. performed the same/extremely similar surgery that we were requesting. We spent hours writing letters, making phone calls, more letters and calls. Nothing! Cole was only 5 months at the time. Dr. Nath's office informed us that the mod quad would be 5 grand...so we were willing to pay for it independently, but a week before surgery...it became 15+ grand. I remember curling in a ball on the floor and crying "Why?"

Well...I think my question was answered. We searched the country and I had more time to research. Now I feel thankful for what our insurance wouldn't cover back then.

Have you contacted Shriners Hosp in Philidelpia Dr Kozin also does the same surgerys and there is no charge what so ever he wouldn't do Frankies because he was 14 at the time and he felt it wouldn't do much good but your baby is so young and he is another great BPI doctor you can email him and he will respond I will see if I can find his email address. Don't give up hope I know what your going through and it will work out. Mare