Kaiser denied my daughter's pediatrician's referral to an outside Dr @ Stanford medical? Help!?
My 20 month old daughter may have Rheumatoid Arthritis. We need to go see Kaiser's pediatric rheumatoid specialist. He is located at Kaiser's Oakland facility but is only there 1 day a week. According to my daughters pediatrician we need to get my daughter in for an appt within a week or two since the swelling in her knee is so severe it might cause permanent damage to her leg if left untreated too much longer.
Due to the Dr only being in Oakland 1 day a week our appt is not scheduled for a month. If we want an appt sooner Kaiser said we need to travel to Sacramento (where the rheumatoid pediatrician is stationed). Sacramento is 3 hours away!
My daughter's pediatrician put in a referral for us to see a Dr at Stanford Medical which is only 45 minutes away and they can see us within the two week timeframe. Problem is Kaiser denied her referral. I am going to appeal it. Please give me some pointers on going about the appeal process and what I should say.
somehow i know you are not going to like this answer but allow me to make it short and sweet. sacramento is 80 miles away from oakland - 3 hours?
if you are really so gravely concerned about your daughters well being, get in your car and drive up. yes Stanford medical center has a nice ring to it, but you are insured with kaiser.
Sorry for your daughters condition, but your best bet is to get a lawyer who is familiar with medical law and follow his instructions.
Considering the urgency of the situation, I think you should take a day off from work and drive to Sacramento. If you leave after 9 am, there shouldn't be much traffic, and it will only take about 1.5 to 2 hours to get there from Oakland.
You should still file the appeal, but it probably won't go through in time. And as for what you should tell them, how about that you are extremely dissatisfied and are going to switch insurance companies as soon as you can?