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Subject:
From:
Trisha Cummings <[log in to unmask]>
Reply To:
St. John's University Cerebral Palsy List
Date:
Tue, 29 Jul 2003 10:26:43 -0400
Content-Type:
text/plain
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Hi Again Kyle,

         Well, why does that matter - the "good" usually acts as an aid to the CP side - at least that is what I have noticed with Amber -  The 'Good" side - acts a cantilever and allows her to use the CP side - incapitate the "good" side and she is literally hampered in her movements -  No I realize ahe is a right hemi and perhaps more involved than you but I would like feel every precaution is being taken for your safety - before -during and after. At what point does a doctor have to review the file at the HMO. Perhaps your Dr. can request that. I hate HMO's. Our medical care has gone to hand in hell basket.

                                             Trisha

> -----Original Message-----
> From: Cleveland, Kyle E. [SMTP:[log in to unmask]]
> Sent: Tuesday, July 29, 2003 10:04 AM
> To:   [log in to unmask]
> Subject:      Re: Hey all
> 
> 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

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