Woo hoo. That is great 
well, the next hurdle is if you need or want surgery…with this doc, is to get past the hurdles with insurance covering this doc to do your surgery. You wont be able to self-pay for that one…LOL
If you can prove no one else experienced in Denver area on your plan, you can appeal to get Hepworth. Usually you can go out of the managed care system with a PCP referral. Having the consult report from Hepworth will help. let me know if you need some help on that. Get the plan documents i suggested and I can research it for you.
I really appreciate this! That’s why I still brought my CT to the other doc- I suspect that if he says there’s nothing he can do/he doesn’t want to do surgery and Hepworth DOES, I can opt out of the managed care plan on the argument that there’s no one in the managed care plan that does what I need done. I would be totally fine being on regular Colorado medicaid, I think everything else I need medically would go from being free to being like $2-3 a visit or something which is totally fine with me, it’s just a matter of convincing them that I need to switch plans.
Also, my PCP doesn’t know a lot about ES so she hasn’t been a huge help, but I’m pretty sure she’d write me an out-of-network referral if I asked and she could.
I’ll poke around for those plan documents and see what I can find out! Thanks again!
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Hi @kittchenita I’m so sorry you’re going through hassles with insurance and this other doctor that is wasting your time. I am also in Denver and also on an ACA plan; it has been a real hassle trying to deal with this extremely painful issue and navigate my crappy insurance. I’m trying to get on my partner’s plan now to make things easier.
I am seeing Dr. Hepworth for very similar issues and I can assure you he is extremely caring and gifted at what he does. I am not sure I’ve ever seen a specialist with such a great bedside manner. He has told me repeatedly “I believe you,” that there is a scientific reason for my problems, it’s not “in my head” or “panic attacks” as I was previously diagnosed. He is very thorough. I still do not have a firm diagnosis as he is checking all of the peripheral things, but he has brought up Eagle syndrome as a possibility. He also has sent me to other doctors for various tests, mainly a CT scan, a vascular ultrasound, examination of my eyes for papilledema (optic nerve swelling). Last time I saw him he referred me for a cerebral angiogram. He said “look me in the eye: this is not a transition of care.” That meant a lot to me that he is not giving up on my case. I am supposed to see him roughly a week or two after this procedure but am still waiting to schedule. His scheduling people are not the greatest (they are gatekeepers, like most scheduling staff) but his nurses and PA are very professional and kind. I am confident he will tell you within the first appointment if this is a potential issue if he can see your CT and he will not waste your time! If you have any questions please reach out and message me. There are a few others here who see him and our journeys have been very very similar. Hang in there!
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Thank you, blossom! I’m pretty desperate for someone who will believe me and advocate for me (which is pretty ridiculous considering my main symptom is my voice… they can hear that I cannot y’all properly). Hopefully I’m nearing some answers here- I had another doctor diagnose me with ES but was wishy washy on whether surgery would help, so hopefully Hepworth will see it and will make quick moves to fix it. It makes me feel good to know though that he’ll make an effort to think even outside MY box. I know a lot of you are likely in the same boat, but I honestly don’t care if it’s ES as long as I can find a doctor who has an idea of what it could be and is interested in treating me.
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The time you stop trying with a specific doctor is when both your gun barrels are empty. You don’t stop, bite the bastard to the bone and don’t let go.
If then you don’t succeed give them both barrels and move on to the next…
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Hello, Ive been out of touch and not able to get on much since I had a fall last week and took my 1st ambulance ride in my life. 
Ive What is the status of getting an appointment with Hepworth? Have you made it past the gatekeepers? I hope so!
Snapple, hope you’re okay after your fall? Thinking of you, & sending you a gentle hug…
Hey Snapple! Yes, appointment with Dr. H is Tuesday. Paying out of pocket for this one which is fine because I’m likely to be getting kicked off of Medicaid soon anyways. Hope you’re doing ok! Sounds like a not fun experience!
I feel like I would operate under this logic if it weren’t that this is someone I’m hoping will cut me open. I feel like some trust in that relationship is important if you can get it somewhere.
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Woo hoo. Glad to hear you finally got in! Please let us know how it goes.
Thanks for asking Jules. I’m more embarrassed by the fall than anything. Head injuries can be pretty bloody even when not deep and freaked out my kids. I guess they (EMT) felt is was enough to take me in. What is troubling is that I dont remember anything except puking on my feet out at the curb when we were leaving. My kids say I would look at them and my eyes would track but its all dark to me. Ive had kinda a throbbing headache all week but nothing compared to when my ES has a pain flair. They say I didnt have a concussion (via CT results) but I have no doubt I did based on my symptoms afterwards. Even yesterday, I asked my daughter the same question within about 15 minutes and she said we just talked about that. This was a little unsettling. Ive been lying pretty low and resting alot.Ill survive though.
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Whelp, I called today to confirm which office my appointment was going to be at and was told by the receptionist that the person in billing I spoke to must have been misinformed when she told me I could self pay. My appointment was supposed to be tomorrow and the next available one is on 9/29. I’m so frustrated- waiting on hold with the Medicaid people to see if they can just cancel my coverage now since it would end at the end of the month anyways, but I have my doubts.
Update: Just got off the phone with my insurance people, who say I should be able to self pay whoever and wherever I want, they just can’t bill through my insurance. Unfortunately, Dr. Hepworth’s office is closed at this point so I won’t be able to call and tell them this information until tomorrow. I’m planning on just showing up for my appointment and seeing what happens- hopefully they’ll take me.
kittchenita,
I totally agree w/ the Medicaid people. Doctors’ offices can’t be exclusive like that. I think the receptionist is mistaken. After all, she’s at the front desk not in the business office so why would she have a clue about the finer points of the business practices in the office?
Yes, that’s why I was confused in the first place. Medicaid office was like… we don’t have documentation on this because of course you can pay for what you want when you want out of your own pocket as long as you don’t try to bill us.
She said she spoke to the billing person, but my current thought is that she phrased her question wrong and the billing person still thought I wanted them to bill through insurance.
I don’t care regardless as long as they don’t turn me away tomorrow. Planning to get there early so I can get Medicaid on the phone if necessary. Feeling extremely frustrated that this of all things is something I’m worrying about right now.
Well as I may have mentioned previously, if the office accepts medicare and falls under federal rules…they cannot by law balance bill for the office visit for medicaid. In my case, I called all over the place and filed complaints against this doctors office and this was with medicaid as secondary and we had great primary insurance. I called medicaid, medicare, state insurance commissioner, you name it. None could believe this office doing this and I escalated it to the Office (practice)manager. Its a way to have zero liability for balance billing or charging you. In my case it was a practice policy. You cannot believe the complaints I filed over this issue and then they ended up lying about it when they were investigated.
Hopefully this person didn’t cancel your appt. I would just show up and keep your fingers crossed. Maybe tell them you saw to it that your medicaid was cancelled? And that medicaid said it wasnt a problem now? I actually would limit what I said. Sometimes saying too much will hurt you. Check in and hopefully any paperwork you fill out, just check the box no insurance. Good luck. Hang in there and persevere. You have made it this far…
Thanks Snapple. I guess I would understand more if it were a practice policy, but she’s insisting that it’s a Medicaid policy. I’m trying to decide if I should tell her, if she asks, that Medicaid said it was fine or that I cancelled my Medicaid (which I did, it just isn’t officially cancelled until the 9/1).
I specifically asked her not to cancel the appointment because I was going to try to figure something out with Medicaid, so I really hope that she did not.
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Maybe you will luck out and someone else will wait on you when you arrive? In that case, just play dumb and don’t say anything unless asked.
If it is a practice policy, saying medicaid says its ok might not get you very far. My only suggestion would be is to call medicaid back tomorrow and get a supervisor on the phone to verify its ok. Get her contact number for doc office to call and verify with her. CYA
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This is an EXCELLENT idea. Thank you. I didn’t really know anything about balance billing/Medicaid and I did a little research. It seems like she might actually be right that they can’t have me self pay if I’m on Medicaid. Which I really wish were literally anywhere in the patient documentation because I would’ve cancelled my Medicaid months ago if I’d known. I feel like my hands are tied, and I’m confused why if this is true the person I spoke to today did not mention it.