I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

And I will continue to tell ANYONE and EVERYONE I know about how horrible their staff is.
It's SO unfortunate because I love my doctor there, but I had the most awful experience today with the staff.
As most of you know, we've had a terrible time finding the right formula for Ava. She has a milk protein allergy and a soy allergy. It's so bad that even Alimentum and Nutramigen make her sick.
So, my doctor prescribed Neocate formula. It is EXTREMELY expensive, and I cannot afford it out of pocket. I spoke with my insurance company after we were denied coverage for the formula and they said that they need to speak directly to my DOCTOR, and not the insurance claims person in the office becuase they need to know that it is medically necessary in order for them to cover it. But that if my doctor calls them and tells them that it is medically necessary, they will resubmit it, and we will not have to pay for the formula at all. GREAT! Right?


NO, not great. Last week, Ava needed to be seen by another doctor while ours was on vacation. This was before we knew the claim was rejected and I asked someone in the office if they could check to see if there was an update on the formula situation. The insurance person in the office proceeded to yell at me. She said, "I TOLD YOU SOMEONE WOULD CALL YOU WHEN WE HEARD FROM THE INSURANCE COMPANY" Um, oooooooooK. So I get the call from the dr.'s office that the claim was rejected. Now, my doctor was still away. That was when I spoke to the ins. comapny and they told me they need to talk directly to my dr. Ok, great. I call the dr.'s office today becuase he's back in the office. I leave a message FOR THE DOCTOR that I need him to call me back regarding the formula.
Phone rings five minutes later. It's the ins. girl from the office who yelled at me last week. She yelled at me AGAIN! Telling me that the ins. company lied to me and that they will not cover it, and that whoever I spoke to lied to me. I questioned her why SHE was calling me back when the message was for my DOCTOR? She yelled, "This is MY job!" I proceeded to thank her for doing her job, but told her that the next phone call from their office better be from my doctor and I hang up.
Five minutes later...crazy ins. girl calls back AGAIN to tell me that I'm wrong. Now I'm ****** OFF. I tell her not to call me again and hang up.
SHE CALLS BACK AGAIN! I put JT on the phone because he is the calmest person I can think of. She starts screaming at HIM! He said to her, "Excuse me, but isn't it true that if a claim gets submitted and denied that there is a way to REsubmit the claim and process it the RIGHT way so that the insurance covers what you need it to?" She says NO. BULLSH-T! So he hangs up.
SOMEONE CALLS AGAIN to harrass us and yell at us.
By that point, I was in tears.
What the hell is wrong with these people? This is about MY DAUGHTER and somethign that is MEDICALLY NECESSARY inorder for her to thrive. Why is my doctor's office working AGAINST me when they should be advocating FOR her?
My doctor FINALLY just called me now and I said, "Your ins. claims person said that my ins. company won't cover the formula if she's not tube fed, but when I called my ins. company they said that's not true. They just need YOU to call them to tell them it's medically necessary for her to have this formula, then they will cover it." So, what does he say? "Of course. That's how this works." Then I told him that while I really like him as our doctor, I can no longer use a practice that does not have my child's best interest in heart. I told him everythign his insurance person told me and my husband, and told him I will not be returning to their practice.
Like he even cared.
I'm just SOOOOOOO upset. I am sick to my stomache over this and am horrified that this happened. And I will not stop telling this story until everyone I know has heard it. I will not allow some idiot in a dr.'s office to stand in the way of my daughter's health, and I will make sure this does not happen to anyone else.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

Rachel - I am sooooo sorry you have to go through that crap!!!

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

I'm so sorry Rachel.

I'm just curious though... which dr. is this?

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

That is absolutely unacceptable. I would write a letter of complaint and send it to the practice. I would mention the ins biller and her name in the letter. Lorimarie and I go to a wonderful practice in Commack. FM me for the info if interested. I know her DS had formula issues and she was very happy with them

Message edited 8/14/2006 2:07:30 PM.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

I am so sorry this has happened. It really is a shame that the people that work behind the scenes at a Dr's office treats patients this way.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

I'm sorry you went through this. I am even more sorry that your Dr. didn't take the initiative to comfort you after you told him the story.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

OMG Rach! That is horrible. I am glad you are NOT going back there. That is no way to be treated! They obviously dont have Avas needs in mind when they are doing their "work". what a horrible thing for you to have to go through. Especially when you finally found something that works...why do thing have to be so difficult? I have a great drs office that I am happy with so FM if you need a referral - not sure if you have someone els epicked out already. I am glad Ava is feeling better though!!! Dawn

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

I am so sorry you had to go through all of that. That woman in his office should be fired!

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

Wow - that is horrible the way they treated you. I am so sorry you had to deal with that ******.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

So sorry to hear that! Some people are unbelievable. I have a doctor in Commack that I love, if you need a recommendation.

Good Luck!!

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

I use Smithtown pediatric group as well..but never had a problem...the staff does seem a bit unknowledgeable so I can def see where you are coming from...which DR were you seeing?

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

There is a GREAT practice in Smithtown- Smith Haven pediatrics- across from St. patrick's Church. Dr. Susulski is our Dr. 361-2121

Fabulous, caring staff. I can't say enough. And its no problem to speak to the Dr. He returns calls quickly.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

That is absolutely horrible. I was wondering if you could take Ava to the hospital and have all this insurance BS cleared up that way and put in tact. I worked in a hospital and sometimes the necessities are only given when the hospital gets involved. Especially since you said shes not eating. Whats wrong with these people.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

That is so horrible! Some people go way to far! I'm sorry you had to deal with such an idiot

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

This is the last thing you needed. If that woman calls back one more time, I would call the phone company. I think you should document what happened & send a certified letter to the doctor indicating if he ever switches practices to let you know.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

That is absurd, and I am so sorry you had to go through that!!! What an awful experience.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

I am so sorry that you had that experience. As if you haven't been through enough with all of the problems you've had trying different formulas!

I hope you find another doctor who supports you 100% and who is wonderful for little Miss Ava.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

OMG, I would be FUMING! DEFINITELY send them a letter... that's just awful!

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

I am so sorry you had to go through that!!! What a horrible experience...you should have a sit down with the doctor!

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

Rachel,
That is so terrible what they are doing to you and your family! I would write a letter and report it to whoever will listen. Best of luck finding a new practice. Hope things turn for the better!
Christy

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

Rach this is terrible!

Im very happy with Ryans Dr. and their staff- if you want their info.. let me know!


I hope this all gets taken care of!

Re: I take back ANYTHING nice I ever said about Smithtown Pediatric Group.

OMG that is truly horrible