This week I am staying with a friend who used to work as a case manager on the insurance side of authorizing procedures. (Another confirmation to me that I am heading in the right direction). She has given me some information that may prove helpful as I walk the process with my insurance company. I want to pass that on to you, as some of you may find it helpful, also.

According to my friend, call your insurance company and ask to speak to a case manager or a nurse manager. If you cannot speak to one directly, ask if one could be assigned to your case. Some of the insurance companies may not know what case management is all about. (Especially if the person answering the phone is just a general receptionist.) In that case, ask them if they have a unit that negotiates for non routine, potentially more costly care or procedures. The person who is the case manager is usually an RN. They specialize in negotiating the various components of the procedure. The important thing to emphasize is that you are seeking treatment at a "center of excellence", and that the facility and surgeon you are asking for is non network but has the most experience with doing MVD specifically for HFS. Ask if they could negotiate with the surgeon/ facility or make an out of network exception. Stress that the facility and surgeon where you are seeking treatment is recognized as a center of excellence for the MVD-HFS procedure.

In my case, Allegheny General Hospital is approved by my insurance company, but Dr. Jannetta is not listed in their PPO list. So I will be attempting to negotiate approval for Dr. Jannetta to do the surgery. Since my last Botox shot was April 30, 2003 I am not planning on having the surgery until March or April 2004. However, I am in the United States until September 2, 2003, so thought I should do as much legwork now as possible, since it's easier and cheaper to make phone calls here.