Shriners Hospital | Imamother

amother

Seagreen

Tue, Nov 22 2016, 5:13 pm

Anyone have experience with Shriners Hospital in Philadelphia? I have a very large deductible for medical equipment and was thinking of going there for my dd. She had JRA and will need new orthodics every few months as she grows. Also, anyone know if they cover medications? Our insurance company is giving us a very hard time with approving the medications that her Rhuemotologist suggested.

amother

Magenta

Tue, Nov 22 2016, 5:35 pm

Fellow JRA mom here, just wanted to extend my empathy and support. I don't have experience with Schriners but I do know that they have an excellent reputation and know others who have accessed their services. They are supposed to be top rate, so I would definitely trust them for orthotics.

I don't know about medications at Schriners, but I get you on the astronomical costs if JRA meds. Be persistent with your insurance company. Also, if they continue to refuse, the big drug companies have financial assistance programs, so you can contact them and see what they offer (Humira, Enbrel, etc.). I don't know what meds your child is on, but the rheumatologists office should be able to advise you on steps you should take to access the appropriate meds. My doctor gave us a copay card for the assistance program which saves us the very high copay from my childs medication.

Fox

Tue, Nov 22 2016, 5:41 pm

It's been 20+ years since I had experience with Shriners Hospital in Chicago, but I think the model is essentially the same.

You can call or have one of your doctors call for an intake interview, which is typically done over the phone. You'll have paperwork to complete to establish the diagnosis, the recommended treatment, and your income/resources. Usually your physician(s) will need to send additional information about your DD, as well. Although it is income based, they are very compassionate and sensitive about it.

In my experience, they only provided medications directly related to whatever treatment or procedure was being done. However, everything is done on an individual basis and this was many years ago, so it's definitely worth asking about.

It's an excellent way to get access to top doctors who might not be part of your insurance network or who don't have much availability for new patients. My DD got one of the top hand surgeons in the country who only came to Chicago a few days a month, one of which he spent at the local Shriners Hospital.

If you're having trouble getting your insurance company to cover prescribed medications, I would also suggest seeking an attorney whose primary practice is suing insurance carriers on behalf of care providers. They will sometimes take a case pro bono or for a reduced fee because it gives them chance to gain a psychological advantage over the lawyers representing insurance companies that they face regularly. It's very hard for a judge to rule against a child who needs medical care, and the insurance company lawyers dread the prospect.

When this happened to us many years ago, a federal judge heard about half our story and told the insurance company lawyers, addressing them by name, that they were to go into the hallway and settle, and that they should pray they never crossed the door of his courtroom again.

Hatzlacha, and a refuah shleima to your DD!

amother

Seagreen

Tue, Nov 22 2016, 5:59 pm

amother wrote:

It's so comforting to hear another mom is going thru the same thing. Her doc wants to switch her from methotrexate to enbral. Insurance company won't approve it and wants her to take humera but she's too small for that, only 10 kilos. I'm going to call Shriners tomorrow become at this point I'm ready to do anything for my dd to get her pain and swelling under control.
Between her PT, OT, early intervention and medications, hope she gets some relief.

amother

Seagreen

Tue, Nov 22 2016, 6:06 pm

Fox wrote:

I hope to not go down that road but if I have to I will. Thanks for the advice and hope something will work out