Well, after harassing "Ryan" (not his real name) at my Doctor's office this past week (total of about 10 phone calls/messages), I was able to get the determination from my Medical Group that my request for surgery at UCLA was - DENIED.....Bummer.
So, how do I feel about it? Still processing it all, I think. Still asking the simple question of who is it that makes the decision to "Denied (sic)" my request. The request seemed reasonable. I thought so and I am the most reasonable person that I know.
So, this average reasonable person read my request and said no. They took into consideration (I am sure) that I wanted to go to a surgeon (an expert in cancer of the head and neck - oh, that's what I have), to a hospital that is in network that specializes in cancer (its all they do); but he is not in my medical group. I am sure they did all of this. And this person made this decision without ever talking to me. Me, the one with the tumor. Me, the one with the occult primary cancer. Me, the one who waited for seven (7) days to find out if the referral to UCLA would go through - not! No wonder health care in the states is the way that it is.
But, I need to have the surgery. I want to have the surgery. I have given enough to my "friend" on my neck and the time has come to cut it out.
PS: I was asked to add the ability for folks to leave comments. It took a while, but I finally figured it out. Just click on "Comments" below.
4 comments:
Gary,
Don't forget that The Man Above has a huge say in this. I've found that his path has always been the better path for your brother, your niece, and myself. My prayer is that you are able to hear Him in your heart and mind. I think He ultimately made the decision of where would be the best place for you to have your surgery. Please take this into consideration and listen for Him . . .sometimes He yells and sometimes He whispers.
Love you!
Deb
oxoxo
Excuse me...but...when in the hell did you ever accept no as your answer??
What insurance do you have? Do they have a unit that deals in 2nd looks at prior authoriazations? I am a bitch..put me in charge of this part....
Love to all of you...
Susan
PS> LOVE the comment section!
Cousin Gary,
I am sorry to hear of this set back. You must have an HMO insurance! Unfortunately, it sounds unfair but that is exactly how HMO's work. The IPA medical group you are assigned to usually will not refer outside of their IPA medical group, unless you are requiring a higher level of care at which they are not able to provide. DO NOT TAKE NO for an answer! By law you are entitled for a 2nd opinion paid for by the insurance, as well as to have that 2nd opinion physician perform the surgery. Call the insurance company directly and asked to speak to case manager. If your IPA is on top of things, they should have already contacted your insurance and had a case mgr assigned to your case due to your recent diagnosis. If all else fails...inquire about an urgent transfer to a primary physician at UCLA. Three years ago Anthony went throught the same ordeal with his insurance. His wife Ronda became very ill with multiple blood clots in both lungs and bilateral lower extremeties. Her assigned hospital was not rendering the adequate care she required. After 8 hours, not only was she on her way to losing her leg, but possibly her life. We immediately called the insurance directly. In a matter of hours, all her medical coverage was switched over to the physician and hospital of our choice. She was immediately transferred and received the higher level of care she needed. I truely believe Ronda is alive today because of that call! Sometimes it takes a bit of pushing and shoving in order to get what we need from these insurance companies! If I can be of any help let me know. You mom knows how to get in touch with me. My prayers are with you cousin.
Love ya cousin Francine
Gary,
I am shocked that you were turned down for surgery that can help save your life. Wow, are things REALLY messed up! I know through your diligence and God's love, you will come out on top!
Alyse Adams
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