Comment by Cindy on December 1, 2008 at 1:03pm

This sounds unfair..I did not have this happen to us. I would think your insurance should pay for doctor visits to the derm and what ever meds he prescribes..I know our med is not covered by insurance, but it is not too pricey. Who is your insurance with?

Comment by Rose K on December 1, 2008 at 1:14pm

+I suggest you contact the National Alopecia Areata Foundation (NAAF) at www.naaf.org 415-472-3792 and ask for the insurance filing packet. It's full of info to help those of us with AA tackle unfair insurance company practices. Good luck.

Comment by Lyndsey on December 2, 2008 at 7:45am

WOW! How cruel can they be! We have been fortunate and not experienced anything like this yet. We return today to find out the results of Lyn's tests. We're al a little nervous and excited at the same time, if that's possible. The initial tests that you mentioned should be covered by her insurance to begin with... including a scalp scraping. I wouldn't even mention to them that it's AA... I would tell them straight up that she's ill and the sympotoms she experiencing and as what tests they would approve also. If they disagree have the doc be sneaky about it and have them do it as her yearly physical.

Comment by Tammy -mom of Ramsey on December 2, 2008 at 8:51am

We have already had one claim denied (our initial doctor visit), and ended up having to file a grievance and they are going ot pay that initial claim. However, they made it clear that no other "alopecia" claims will be paid. Alopecia is a "cosmetic" issue and it is clearly written out in thier policy that alopecia is not covered. They will not pay for any visits, tests, or medication related to alopecia. I did contact the NAAF. They can not do much, because what they do is help get insurance to cover wigs. We are going to the Dermatologist next Friday. I am going to tell them that we are there to look at my daughter's mole on her neck (I am not worried about that, I think it is fine), and ask them to make that the diangnosis code. Would you believe my daughter's pediatrician would not even order her a thyroid test until after she saw the dermatologist? The pediatrician said if we come back and let them see her agian, they'd consider the thyroid test (all the women in my family have major thyroid issues), but they would not run her blood sugar, lupus,Iron, or any other things that could contirbute to this hairloss. I am not sure if the Dermatologist can get away with ordering these tests or not, but that is my hope right now. The pediatrician said they "don't think those tests would relate to the hair loss." Now if we went back to the ped. to get the thyroid test ordered, we'd have to pay the $75.00 office visit. I feel like no one cares about my little girl. If it comes down to lying about her symptoms to get the tests, I guess I'll probalby lie. I know it is not right, but I'll do it anyway. I will try to contact CAP -see what they say.

Comment by theantichick (Shannon's Mom) on December 2, 2008 at 11:52am

This seems so wrong. There are a number of very serious health issues that have to be ruled out before the diagnosis of AA can appropriately be applied. My pediatrician ran a number of blood tests before referring us to the pediatrician. There are hormone imbalances, deficiencies, other autoimmune disorders and even a few juvenile cancers that can cause hair loss and need to be tested for and ruled out! (Not trying to worry you, the autoimmunes & cancers aren't common or particularly likely, but it's part of the standard diagnostic procedure to make certain it's NOT any of them...) I would fight this, and get as much documentation as you can from medical texts and professionals to back you up.

Good luck!

Comment by Tammy -mom of Ramsey on December 2, 2008 at 12:23pm

I am not sure who to go to.

Comment by Tammy -mom of Ramsey on December 2, 2008 at 12:24pm

:(

Comment by Lyndsey on December 2, 2008 at 1:22pm

I basically had the dor slammed in my face by Lyndsey's first pediatrician. She informed me back in the late part of September when this all started that Lyn's well child check-up would be coming in Jan or Feb and we would deal with it then. I told her I wasn't comfortable with such a lacksadasical approach and would have our healthcare needs serviced elsewhere. I chose a new peds. that day and it took 7 weeks for our new office to get the records from our old peds office as they had to be "signed off on". What B.S.... I was so ticked off and all the while my child was left to suffer. One visit with the new pedi. and we had all the test we needed ran. The results are in and we'll find out today what the heck is going on. I only pray that your insurance co, and physician have a change of heart and give her the help she deserves.

Comment by Tammy -mom of Ramsey on December 2, 2008 at 1:49pm

Okay, ya'll...This is my thought, and I need your opinions. The Dermatologist appointment is next Friday. I think I'll wait and go then and tell them about what I am experiencing. If they don't seem to care, I am going to call our old pediatrician (W e left on good terms as ot wasn't an issue on the level of care but the waiting and cancelations they gave us), and see if they'll take us back. Then Call a dermatologiast on the list I got from NAAF, to see what they say (if we ended up goning there, it would be an 1 1/2 drive though). I'll also appeal the insuarnce with the information sent to me by NAAF (but I don't think it will do any good). I am not sure what else to do though. I hope this dermatologist is very good and supportive and really wants to help us.

Comment by theantichick (Shannon's Mom) on December 2, 2008 at 1:58pm

I think you have a good plan. The dermatologist can order any test the pediatrician can. I'm not up on my ICD-9 (insurance payment) coding, but there should be some codes for diagnostics and ruling out things. The doctor has an obligation to rule out the conditions I mentioned above, and the insurance company should not be able to deny payment for those tests. (doesn't mean they won't TRY, but they shouldn't be able to get away with it) My question to a doctor would be why is s/he NOT following generally accepted medical protocols and ruling out other conditions (wording it like that opens them up for a malpractice problem if they don't), and if the paperwork is filed properly the insurance company should have to pay it, even if it takes some doing. (I had to fight for 8 months to get approval for a knee surgery I had to have, so I know about fighting insurance companies...) This isn't about paying for AA treatment, it's for making certain there's not something going on that's NOT AA and that needs treatment they DO have to pay for.

I know how frustrating this all is, it makes my blood boil when doctors don't do the right thing, and insurance companies are of the Devil in my book. :(

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