Surgeons Question

[DLH]

I am still trying to get my out of network referal from my HMO. I was trying to go to Dr. Chitwood in N.C. and my HMO denied it, but said they would approve me to Dr. Klodell @ Shands in Gainesville because they have a contract with Shands. Both Surgeons seem very confident that they can repair my mitral valve, both do minamally invasive, the only difference is that Dr. Chitwood would more than likely use the robotic surgery. However, I will have to go through an appeal to possibly get approved to go to Dr. Chitwood.

Has anyone heard of or had surgery by either of these 2 surgeons?

If you were me which one do you think you would prefer?

Thanks for feedback.
DLH

 

[Karlynn]

Is there a particular reason you want the robotic surgery?

 

[DLH]

Is there a particular reason you want the robotic surgery?

Actually my primary concern is to go where I have the best chance for a repair and not a replacement. I feel that this is largely determined by experiance and # of mitral valves repaired successfully and complexity. It seems hard to get any factual numbers from the surgeons. All of them seem to be extremely confident in themselves, which I is good but I feel hinders in making a decision. Everyone may think they are the best, but I want facts.

Second, I want minimally invasive which is not offered in Tallahassee. The reason for this is because I need the quicker recovery time. I am 40 have 2 kids and a wife and we depend on my income. I have some sick\vacation time but not enough to cover being off after a sternotomy and short term disability will not cover my whole salary (maybe half, but you must be out 2 weeks first).

The robotics is last consideration. I have heard of benefits like less chance of infection, quicker recovery because it is the least invasive, better 3d view of heart during surgery and it also removes any hand shake or movement that the physician could have. The only negative I have heard is that the surgery may take a little longer.

 

[samiam]

I went minimally invasive mitral at Cleveland Clinic, Weston/Ft Lauderdale.

The surgeon, Dr Boyd, has done lots of mitrals and lots of robotics (he's in charge of robotics). In my case, he suggested I not go robotic. He was concerned that my mitral valve "might" be too damaged to be repaired. If he started robotics and decided the repair wouldn't work, he would then have to sew me back together, roll me over, and do it through OHS.

So we just planned on a minimal invasive. As it turned out, my valve really was too messed up and had to be replaced, which, he said, can't be done robotically, yet.

Good Luck on your decision.

 

[Jcwillie]

Dr.Chitwood did an AVR on me in june.Iwas out of hospital in three days with only a four inch scar .Back to work in four weeks.He's not only a good surgeon,but he has had OHS himself so he knows what you're going through.
The staff at Pitt memorial were great as well.

 

[KristiinSD]

Your situation sounds painfully similar

Your situation sounds painfully similar

I wanted to go out of network and now 2 months later, I am waiting for the 1st of November when I will be switched to another medical group. I appealed and argued, had the support of my primary care physician, surgeon, submitted journal articles, etc. but they would not be swayed. At some point I stopped fighting as I thought it was probably worse for my heart to fight rather than wait (I consulted my surgeon first, however, to make sure waiting was okay).

Now, my surgeon is talking about doing my surgery robotically as well. I am excited about this because I think the research has demonstrated that folks go home in half the time, heal much faster, and report better "quality of life" with the same number of complications that non-robotic minimally invasive surgery typically yields. I'm a single parent and while my ex will care for my son for as long as necessary, my son is not exactly thrilled with the idea of being at Daddy's for a long period of time.

So, in answer to your question, I guess I would go robotic although I think Shands is an excellent hospital.

Kristi
mr
surgery sometime soon?

 

[DLH]

I wanted to go out of network and now 2 months later, I am waiting for the 1st of November when I will be switched to another medical group. I appealed and argued, had the support of my primary care physician, surgeon, submitted journal articles, etc. but they would not be swayed. At some point I stopped fighting as I thought it was probably worse for my heart to fight rather than wait (I consulted my surgeon first, however, to make sure waiting was okay).

Now, my surgeon is talking about doing my surgery robotically as well. I am excited about this because I think the research has demonstrated that folks go home in half the time, heal much faster, and report better "quality of life" with the same number of complications that non-robotic minimally invasive surgery typically yields. I'm a single parent and while my ex will care for my son for as long as necessary, my son is not exactly thrilled with the idea of being at Daddy's for a long period of time.

So, in answer to your question, I guess I would go robotic although I think Shands is an excellent hospital.

Kristi
mr
surgery sometime soon?

Sounds almost identical to my situation. I to could switch at open enrollment to another plan if need be.

 

[Donna]

I am also denied to go out of the network and I am suppose to have surgery next month. How does someone go about getting approval to go outof the network.

Your reply would gratly be appreciated
Donna

 

[Adrienne]

So we just planned on a minimal invasive. As it turned out, my valve really was too messed up and had to be replaced, which, he said, can't be done robotically, yet.

If the valve can be replaced with a non-robotic minimally invasive procedure, why can it not be replaced with a robotic procedure? It doesn't make sense to me especially since it can be well repaired (which is harder) by the robot.

 

[netmiff]

Donna, Adrienne, this thread was started in 2005 - I don't know if you are going to get answers from the original posters after this length of time.

Donna, if I were you, I would start a new thread in pre-surgery or heart talk with something like "how to get approved for out-of-network referrals"

 

[Lisa in Katy]

The thread will probably be moved, but here is my answer....

You can submit an appeal, but the fastest way is probably to have your doctor call the Medical Director at your insurance company - it needs to be peer to peer, not his secretary. Your doctor will be better able to explain why it is best (and possibly cost effective???) for you to go out of network. If you are in an HMO and your doctor is part of that HMO, but in a different geographic area than you are in, he already has a contract and both docs will probably agree that they can do a one time deal for you using the already contracted rates. The same is true for the hospital. A word of warning though, you get lots of bills from lots of different people and you may have issues with some of them being paid. Try to get something in writing saying that it is okay for all providers. The hospital based guys aren't usually a problem, but there will probably be a Cardiologist and Pulmonologist involved as well.

 

[Donna]

Lisa,
Thank you so much for your reply.
I have a local surgeon who is in the network and trying to call the ins. company. He does do minamally invassive operation but his experience probably not very high as the surgeon in NYU that I am schedule for surgery with. Unfortunatly surgeons don't have much free time although he seems so nice and willing to help me. He said he will call. Unfortunately today with all the phone options and keeing make it so much more time consuming in placing a simple ph call. But thank you for tip about talking to the medical director, it makes more sence. I will pass it on to this surgeon.
Again thank you so much.
Donna