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