MD's not offering all available options
- Thread starter LUVMyBirman
- Start date
Help Support Valve Replacement Forums:
Ross
Well-known member
This doesn't surprise me and I doubt that it's any surprise to you either. This is the number one reason why we must take a proactive stance when it comes to our own care.
LUVMyBirman
Well-known member
You bet ya my friend! It scares me. For the time being we have a nice PPO. Pray to God we are always that fortunate.
Hey, what's up with the Avatar?
Hey, what's up with the Avatar?
Ross
Well-known member
I'm tired of the same old face and have nothing new to put up. The clown seems to suit the personality, so I'll use him for now.
My good friend MadDoctor has been at it again, but I don't think these are suitable for here.
My good friend MadDoctor has been at it again, but I don't think these are suitable for here.
fyrfytr
Well-known member
Hey Gina,
Thanks for the info. It doesn't surprise me either, and you are right it is nice to have a dr. we can trust. Hey Ross, I like the clown.
Dave
Keep your fires small!
______________________________________
Surgery: 4/21/03
Aortic Aneurysm Repair
AVR, with a St. Jude Mechanical
Heart Center of the Rockies
Thanks for the info. It doesn't surprise me either, and you are right it is nice to have a dr. we can trust. Hey Ross, I like the clown.
Dave
Keep your fires small!
______________________________________
Surgery: 4/21/03
Aortic Aneurysm Repair
AVR, with a St. Jude Mechanical
Heart Center of the Rockies
MelissaM
Well-known member
Clowns scare me.
I vote for lab with pig nose.
As for silent docs - how about this one? My cardiologist said I needed to have surgery within three months. For the next month, his office said they were waiting for surgical opinions to come in, when in fact, they had not even sent my test results to the surgeons yet! Tick, tick, tick. . .that TOTALLY threw me for a loop as I am becoming more symptomatic by the day. When I called my HMO to get them involved and speed the process along, they said one of the surgical consults (the one with Dr. Cosgrove) was "unecessary" and were confident their surgeon could perform an equally good job.
My repair is difficult due to bacterial endocarditis and both leaflets being involved, but supposedly, it can be done. I would like to have the most competent surgeon for the job be able to do it.
Anyone have experience fighting their HMO to get an out-of-network, out-of-town consult or surgery?
Wanting the silent option. . .
Melissa
I vote for lab with pig nose.
As for silent docs - how about this one? My cardiologist said I needed to have surgery within three months. For the next month, his office said they were waiting for surgical opinions to come in, when in fact, they had not even sent my test results to the surgeons yet! Tick, tick, tick. . .that TOTALLY threw me for a loop as I am becoming more symptomatic by the day. When I called my HMO to get them involved and speed the process along, they said one of the surgical consults (the one with Dr. Cosgrove) was "unecessary" and were confident their surgeon could perform an equally good job.
My repair is difficult due to bacterial endocarditis and both leaflets being involved, but supposedly, it can be done. I would like to have the most competent surgeon for the job be able to do it.
Anyone have experience fighting their HMO to get an out-of-network, out-of-town consult or surgery?
Wanting the silent option. . .
Melissa
LUVMyBirman
Well-known member
Melissa,
Do you not have the option to go out of network and pay a %. For a recent second opinion for another matter there was a $100 out of pocket fee. Other PPO's we have had worked on the 80/20 with our current one being 90/10.
I do understand HMO's are tighter in managing care. You just have to prove them wrong and get Cosgrove on it. I feel he's your man!
Curious, are there any stats on repair with endocarditis?
Do you not have the option to go out of network and pay a %. For a recent second opinion for another matter there was a $100 out of pocket fee. Other PPO's we have had worked on the 80/20 with our current one being 90/10.
I do understand HMO's are tighter in managing care. You just have to prove them wrong and get Cosgrove on it. I feel he's your man!
Curious, are there any stats on repair with endocarditis?
Nancy
Well-known member
Health insurance companies pull most of the strings.
It bewilders me that there is so much secrecy on the part of the health insurance companies. To me, secrecy means that you have something to hide, otherwise you would be up front with everything. Just think about it, they deny services based on their own actuarial guidelines and it is to enhance their bottom line. How many of us know who is making these decisions? Are they professionals in the medical field? Do they keep up with research? How long does it take for a new treatment, which has been approved for use by the FDA, to get approval from the insurance companies? How are these people's salaries determined??
Or are decisions ultimately made by people in the financial field, or others who have no background in medical care? How many of the initial decisions are made by people with no advanced training in any field?
In my own opinion, the gag orders which were instituted a while back and supposedly are no longer in effect (or are they?) were just a massive effort to keep the public in the dark and keep them from asking any questions about what was happening to them. Meanwhile health insurance companies denied services, and dragged their feet until the offending "patient" either shut up or expired.
Finding intelligent, excellent and caring doctors is very possible. Joe has them. He wouldn't be here without them.
Helping with your own healthcare is of vital importance. Read everything that is available on your own problems. Know the options and the new treatments, have a good feel for what the right answers are. And ask questions as you need to.
I believe that responsibility for your healthcare is a collaboritive effort. If you know nothing about your health problems, then how can you possibly assess the quality of care that is given.
In this situation, ignorance is definitely not bliss.
It bewilders me that there is so much secrecy on the part of the health insurance companies. To me, secrecy means that you have something to hide, otherwise you would be up front with everything. Just think about it, they deny services based on their own actuarial guidelines and it is to enhance their bottom line. How many of us know who is making these decisions? Are they professionals in the medical field? Do they keep up with research? How long does it take for a new treatment, which has been approved for use by the FDA, to get approval from the insurance companies? How are these people's salaries determined??
Or are decisions ultimately made by people in the financial field, or others who have no background in medical care? How many of the initial decisions are made by people with no advanced training in any field?
In my own opinion, the gag orders which were instituted a while back and supposedly are no longer in effect (or are they?) were just a massive effort to keep the public in the dark and keep them from asking any questions about what was happening to them. Meanwhile health insurance companies denied services, and dragged their feet until the offending "patient" either shut up or expired.
Finding intelligent, excellent and caring doctors is very possible. Joe has them. He wouldn't be here without them.
Helping with your own healthcare is of vital importance. Read everything that is available on your own problems. Know the options and the new treatments, have a good feel for what the right answers are. And ask questions as you need to.
I believe that responsibility for your healthcare is a collaboritive effort. If you know nothing about your health problems, then how can you possibly assess the quality of care that is given.
In this situation, ignorance is definitely not bliss.
L
Les
Nancy,
Your questions about who makes the medical decisions at insurance companies are right on target. A former girlfriend worked at an HMO here in Tulsa. All the case management personnel were required to at least be an RN. However, their supervisor, who had the final say in any decison about treatment had his degree in Physical Education! It was all about the bottom line. Cases reviewed at the beginning of each month had a much better chance of approval than those towards the end of the month when the budget had taken some hits. Needless to say, their legal department was as large as the other departments just to handle the wrongful death suits....
______________
Les AVR '93 / '95
A PPO member, which is how I'm still here....
Your questions about who makes the medical decisions at insurance companies are right on target. A former girlfriend worked at an HMO here in Tulsa. All the case management personnel were required to at least be an RN. However, their supervisor, who had the final say in any decison about treatment had his degree in Physical Education! It was all about the bottom line. Cases reviewed at the beginning of each month had a much better chance of approval than those towards the end of the month when the budget had taken some hits. Needless to say, their legal department was as large as the other departments just to handle the wrongful death suits....
______________
Les AVR '93 / '95
A PPO member, which is how I'm still here....
Nancy
Well-known member
Amazing isn't it?
So many of the people on this board have such complicated, complicated medical problems that frustrate even their doctors. And their healthcare is being determined by someone who doesn't have a clue.
What you have said Les, doesn't surprise me at all. I've spoken to a few of those people. They're in the dark and proud of it! And furthermore, have the admiration of the management level.
So that leaves a lot of us out there in the jungle, swinging on a slim branch without a safety net
So many of the people on this board have such complicated, complicated medical problems that frustrate even their doctors. And their healthcare is being determined by someone who doesn't have a clue.
What you have said Les, doesn't surprise me at all. I've spoken to a few of those people. They're in the dark and proud of it! And furthermore, have the admiration of the management level.
So that leaves a lot of us out there in the jungle, swinging on a slim branch without a safety net
MelissaM
Well-known member
Has anyone had experience building a financial case with HMOs?
The way I look at it, it would be WAY less expensive for my HMO to spend a little more now for a GOOD, LASTING repair, then have to :
1) Replace my bovine valve when it wears out
2) Set me up on a lifetime of coumadin
Any clues on where one could get information on what surgery costs, cost of being on coumadin for life, etc? I feel like the HMO THINKS they will save money by keeping me in town, but they have a very short-term perspective.
Melissa
The way I look at it, it would be WAY less expensive for my HMO to spend a little more now for a GOOD, LASTING repair, then have to :
1) Replace my bovine valve when it wears out
2) Set me up on a lifetime of coumadin
Any clues on where one could get information on what surgery costs, cost of being on coumadin for life, etc? I feel like the HMO THINKS they will save money by keeping me in town, but they have a very short-term perspective.
Melissa
Nancy
Well-known member
I betcha anything that the "good, lasting" part would be the problem. there are no guarantees with any of this surgery, including repairs. It would be you against the insurance industry's data from years ago. Sometimes, they don't even consider new things until they have had a very long, tried and true track record from which to determine their percentages.
I'm not sure how one or two doctor's success rates could sway the data from all the other available options.
Just my own opining.
Someone has put a dollar value on all of this.
I'm not sure how one or two doctor's success rates could sway the data from all the other available options.
Just my own opining.
Someone has put a dollar value on all of this.
fyrfytr
Well-known member
Hey Melissa,
My surgery was in April and the bill so far is around $79,000.00. I had to spend two extra days in the hospital because my red blood count was down and they had to give me 2 units of blood, well we forgot to get that preapproved and the insurance company will not cover those 2 days. They told me that I should of been discharged and than went to the ER and than it would of been covered. I don't get it with insurance! Hope you get things worked out.
Dave
Keep your fires small!
______________________________________
Surgery: 4/21/03
Aortic Aneurysm Repair
AVR, with a St. Jude Mechanical
Heart Center of the Rockies
My surgery was in April and the bill so far is around $79,000.00. I had to spend two extra days in the hospital because my red blood count was down and they had to give me 2 units of blood, well we forgot to get that preapproved and the insurance company will not cover those 2 days. They told me that I should of been discharged and than went to the ER and than it would of been covered. I don't get it with insurance! Hope you get things worked out.
Dave
Keep your fires small!
______________________________________
Surgery: 4/21/03
Aortic Aneurysm Repair
AVR, with a St. Jude Mechanical
Heart Center of the Rockies
L
LoraW30
not surprising.........just think about those who, like myself, don't even have insurance?
i have to admit, right about now, i wouldn't mind having the hassle of an insurance company.
i've had two heart caths withing two months and have gone to see my doc every week for about 4 months. the bills pile up. i am very fortunate to have a doctor who is trying to point me in the right direction as to getting second opinions and such despite the costs.
i have to admit, right about now, i wouldn't mind having the hassle of an insurance company.
i've had two heart caths withing two months and have gone to see my doc every week for about 4 months. the bills pile up. i am very fortunate to have a doctor who is trying to point me in the right direction as to getting second opinions and such despite the costs.
