well, kyle, you know hmo's were a ted kennedy idea
even though you'd never think that from all the
political retoric on hmos.
so blame ted.
--- Genia Voitsekhovskaya <[log in to unmask]>
wrote:
> "Cleveland, Kyle E." <[log in to unmask]>
> wrote:when u are dealing with the insurance think
> good thoughts.
>
> genia
> Yeah, except that I'm a left-hemi and the tumor is
> on the right. They've
> considered the CP with respect to anesthaesia, and
> there was a phone
> consultation with my orthopedic surgeon and
> physiatrist (both local at Ohio
> State University--the bone cutter's a good one, but
> the physical medicine
> guy lacks experience with adult CPers).
>
> Even though cancer is the dx, there is also a
> condition in males,
> gynecomastia, that causes swelling of breast tissue.
> Unbelievably, even
> though the "swelling" in my case is a malignancy,
> the insurance company
> initially told the surgeon that there would be no
> coverage because he used
> the word "gynecomastia" in the dx description and
> the ins. co.'s
> applications are coded to reject pre-approvals based
> on keywords.
> Gynecomastia is one of them. They will not pay for
> breast reduction
> surgery, and this gynecomastia is the dx "word" for
> enlarged breast tissue
> in men. So, my doctor had to get on the phone and
> try to explain to this
> yay-hoo that I didn't have cosmetic gynecomastia,
> but "gynecomastia due to
> malignant neoplasm". I guess he went round-and-round
> with this idiot in
> pre-auth over the word. Something like this:
>
> Pre-auth: "Dr., we don't pay for gynecomastic
> reduction."
>
> Surgeon: "The guy has breast cancer. I just put
> 'gynecomastic reduction' in
> the paperwork because that was the closest code on
> your form."
>
> Pre-auth: "But you checked 'gynecomastic reduction',
> right?"
>
> Surgeon: "Yeah, but only because that was the
> closest code."
>
> Pre-auth: "Sorry, doctor, but we don't pay for
> gynecomastic reduction."
>
> Etc., etc.
>
> All my doctor friends say that dealing with
> insurance companies is ten times
> harder on the physician than the patient. I can
> believe it! My pain doc
> says he spends more time doing insurance paperwork
> than he actually spends
> with patients. The system is "broke" and it's only
> getting "broker".
>
> Kyle
>
>
> -----Original Message-----
> From: Trisha Cummings [mailto:[log in to unmask]]
> Sent: Tuesday, July 29, 2003 9:19 AM
> To: [log in to unmask]
> Subject: Re: Hey all
>
>
> Hi Kyle,
>
> I would think you would need recontructive surgury -
> as don't you have
> spasms? You could seriously injure yourself if the
> incision and surrounding
> area aren't pieced together well. Have they taken
> your CP into account? I
> would get a another opinion - generally one is
> allowed 2nd and 3rd opinions
> - if all recommend reconstructive surgery then you
> have leverage. So perhaps
> a CP expert would be in order.
>
> Trisha
>
>
> ---------------------------------
> Do you Yahoo!?
> Yahoo! SiteBuilder - Free, easy-to-use web site
> design software


__________________________________
Do you Yahoo!?
Yahoo! SiteBuilder - Free, easy-to-use web site design software
http://sitebuilder.yahoo.com