When 14-month-old Fields Parker took a hard fall and appeared to have a broken arm, his father, Tyler, went into action. Understandably concerned for his son’s well-being, Tyler rushed him to the emergency department at Mission Hospital.
Sure enough, the physicians in the ER informed Tyler and his wife, Shannon, that young Fields had broken his right arm. A follow-up appointment was scheduled for the next morning with a pediatric orthopedic specialist. It was critical that Fields see a physician specializing in caring for children with broken bones. Unfortunately, upon arriving the next morning, Shannon was reminded that getting the care they needed was complicated by the fact that Mission’s physicians are not currently in network for her family’s Blue Cross Blue Shield benefits.
It was time to pick up the phone and call Blue Cross. While Shannon had heard several times that there are exceptions to out-of-network rates when the doctor or procedure needed isn’t available elsewhere, she was told otherwise upon reaching a Blue Cross rep on the phone.
“I was given the run around for a little bit,” said Shannon. “I was even told by a Blue Cross representative that they didn’t know about any form that would allow us to be seen by a provider out of network, unless he was a cancer patient. They recommended I call these two specific specialists in Charlotte. I viewed that as really poor care.”
Shannon was understandably frustrated. “The idea of having to drive from our home in Arden to a hospital in Charlotte with a child with a broken arm seemed more than unreasonable,” she said.
So she persisted, and after getting in touch with the staff at Mission Children’s Hospital to discuss the Reasonable Access conditions for the surgery Fields needed, her frustration turned into relief.
“Before the end of the day, Dr. Susan Mims, the head of Mission Children’s, called me personally and said that Blue Cross had approved the surgery that Fields needed,” said Shannon. “Behind the scenes, the Mission Pediatrics staff had been going to bat for my son. I found the hospital staff to be really on point and proactive. We were seen by a pediatric orthopedic surgeon that very day.”
After a successful procedure to repair Fields’s broken arm, Shannon was thankful for the assistance the Mission team provided.
“I felt unbelievably supported by the Mission staff,” she said. “They would’ve stood out regardless of the lack of good care from Blue Cross – but particularly considering the lack of concern showed by Blue Cross in this situation. The Mission staff just really blew my mind. It felt really amazing.”
Shannon felt the need to share her story, so that others know they can get the care they need. Most importantly, she wanted to share an update on her tough toddler.
“Fields is doing great now. Go team Mission.”
Insured by Blue Cross? Certain services for which Mission is the region’s only provider will still be considered in network for many Blue Cross patients if they fall under the Undue Delay/Reasonable Access guidelines. Mission counselors can help you request in-network approval for this care for which travel elsewhere would create an undue delay or excessive burden to you. Call (828) 412-6052 to learn more.