MelissaM
Well-known member
Last week looked soooo good. After dealing with health care beauracracy for over a month, it looked like things were *finally* moving forward. The surgeon I spoke with last week was the first to really listen to the symptoms that developed between when my tests were last taken (on 6/4) and when I met with him (on 7/10). Prior to that, docs were just looking at my test results and saying that I was *fine*. Gosh, I sure didn't feel fine.
Upon hearing my symptoms, the surgeon changed the timeframe for my surgery from 2 months to 2 weeks - slightly alarming - and made a recommendation that I go to Cleveland for the surgery.
Everything looked set to go until Saturday, when I got a Notice of Non-Coverage in the mail. The referral to go to Cleveland had been denied. Of course it came on Saturday. . .and nothing could be done until Monday. . .tick, tick, tick.
On Monday, I was told to put it through an expedited appeals process, which would take 72 hours. That put me at Thursday - a week into the two week timeframe.
On Tuesday, I called the HMO cardiologist to ask about how firm the two-week timeframe was. Was it really more like 2 weeks to a month, what was his opinion, etc.? Before I could even get the question completed, the cardiologist's nurse starts FLIPPING OUT! She hears me say two weeks, and in a very short tone says that SHE never head anything about two weeks, and if I want to keep insisting that my surgery is this imminent, then I need to go back to the heart surgeon and get him to say so (evidently, he forgot to write the timeframe in his surgical notes
). In an amazingly nasty tone, she continues on her tirade and states that she doesn't understand why I keep calling her for help when I am not a patient of the cardiologist she represents and he has never seen me. I try to explain that since he is now the cardiologist making decisions about my future care, he does have some accountability to my case, even if we have only spoken on the phone a few times.
At this point, I am in shock, and close to tears, not believing I have to defend myself in this manner just to get a simple question answered. I try to rewind the conversation and restate my questions, but again, as soon as this nurse hears two weeks, she flips out and angrily states, "if you had only two weeks to live, you would be in a hospital. If you think you are going to die in the next two weeks, then go to the hospital now." Unbelievable.
A complete wreck, I call up a friend to follow up with the surgeon re: the two weeks, and call back the nurse to communicate my frustration at her conduct. The surgeon was on vacation until next week and his nurse didn't know anything about two weeks (again, lack on notation in the notes). BUT since my friend was at the meeting and was able to corroborate hearing "2 weeks," my story seemed to gain some credibility.
She called the cardiologist's nurse back, who paged the cardiologist, who told me not to worry, that if I could be patient for a couple of days, my appeal would most likey be resolved in my favor.
This was nice to hear, but my original question of how critical the two week timeframe was went unanswered. . . I know at some point, the heart sustains irreversable damage, and because my symptoms have increased at such a rapid clip over the past month, I am worried about this. Anyone have any experience with where the cutoff exists and how one knows the "window" is closing?
Upon hearing my symptoms, the surgeon changed the timeframe for my surgery from 2 months to 2 weeks - slightly alarming - and made a recommendation that I go to Cleveland for the surgery.
Everything looked set to go until Saturday, when I got a Notice of Non-Coverage in the mail. The referral to go to Cleveland had been denied. Of course it came on Saturday. . .and nothing could be done until Monday. . .tick, tick, tick.
On Monday, I was told to put it through an expedited appeals process, which would take 72 hours. That put me at Thursday - a week into the two week timeframe.
On Tuesday, I called the HMO cardiologist to ask about how firm the two-week timeframe was. Was it really more like 2 weeks to a month, what was his opinion, etc.? Before I could even get the question completed, the cardiologist's nurse starts FLIPPING OUT! She hears me say two weeks, and in a very short tone says that SHE never head anything about two weeks, and if I want to keep insisting that my surgery is this imminent, then I need to go back to the heart surgeon and get him to say so (evidently, he forgot to write the timeframe in his surgical notes
). In an amazingly nasty tone, she continues on her tirade and states that she doesn't understand why I keep calling her for help when I am not a patient of the cardiologist she represents and he has never seen me. I try to explain that since he is now the cardiologist making decisions about my future care, he does have some accountability to my case, even if we have only spoken on the phone a few times. At this point, I am in shock, and close to tears, not believing I have to defend myself in this manner just to get a simple question answered. I try to rewind the conversation and restate my questions, but again, as soon as this nurse hears two weeks, she flips out and angrily states, "if you had only two weeks to live, you would be in a hospital. If you think you are going to die in the next two weeks, then go to the hospital now." Unbelievable.
A complete wreck, I call up a friend to follow up with the surgeon re: the two weeks, and call back the nurse to communicate my frustration at her conduct. The surgeon was on vacation until next week and his nurse didn't know anything about two weeks (again, lack on notation in the notes). BUT since my friend was at the meeting and was able to corroborate hearing "2 weeks," my story seemed to gain some credibility.
She called the cardiologist's nurse back, who paged the cardiologist, who told me not to worry, that if I could be patient for a couple of days, my appeal would most likey be resolved in my favor.
This was nice to hear, but my original question of how critical the two week timeframe was went unanswered. . . I know at some point, the heart sustains irreversable damage, and because my symptoms have increased at such a rapid clip over the past month, I am worried about this. Anyone have any experience with where the cutoff exists and how one knows the "window" is closing?
