Hospital

[Janet]

Hello. I'm new here. My husband (age 42) has been told he needs a valve replacement. We have many questions. But first, the best treatment center in our area (St. Lukes Mid America Heart Institute in Kansas City) is not covered by our HMO. All other covered choices in this area are unacceptable (based on our research).

We have a cardiologist who is going to appeal to the insurance company to get us covered treatment at St. Lukes. Has anyone ever had luck with this? Any tips on what we can do?

If this doesn't work, we will have to travel for treatment which seems like a lot of added stress. Any comments on that?

 

[Georgia]

GO GET THAT HMO

GO GET THAT HMO

Hi, Janet. This is such a problem. With your cardiologist batting for you, you might have a fighting chance. However, if your HMO is affiliated with another (acceptable) hospital in, say, St. Louis, you may just have to travel.

The travel may be stressful; however, there's no question but that you should go if you must. Consider the number of people who travel to Mayo or Cleveland Clinic from around the world to get the best treatment. The difference in treatment is literally the difference between life and death.

If you're turned down after appeal, it wouldn't hurt to call your state insurance department. They'll tell you if there's anything else you can do to appeal. HMO's are currently on the hot seat due to last week's Supreme Court decision that allows states to regulate them to a certain extent. The HMO's are probably really behaving themselves right now.

Best of luck; continue to come to visit us. You will be amazed at the volume of knowledge and good advice and love and prayers you'll be exposed to at this site.

 

[Kim]

Dear Janet,

I am also from the KC area and had my mitral valve replaced in May, 2001 at Research Hospital and would highly recommend the treatment and care I received there. I had very life threatening complications and my family was extremely pleased with the hospital and my surgeon. For the five days I was on a venilator, I had four nurses 24 hours a day in my room. My surgeon has an excellent reputation in the area for valve surgery and he was great! He even spent the night sitting in a chair by my bed in the ICU. This was after a 14+ hours of surgery! I would be glad to answer any other questions you might have. My understanding about St. Luke's, is that they are no longer the most "outstanding" facility for heart surgery in our area. All of their former doctors, (from whom they gained their reputation) have left to join the staff at KU Med.

Good luck in making your decision. I know how difficult it can be working with an HMO! I too, have an HMO. But, my hospital bill with rehab and surgery and doctor fees, was over a quarter of a million dollars and I paid nothing! It was such a relief!