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Posted by: R Elias ® 02/13/2003, 21:39:34 Author Profile Mail author |
Hi! My name is Lisa. My husband, Rolando, has posted here several times and I've even done a few posts myself in the past. My husband has generalized segmental dystonia with blephospasm and meige syndrome. My husband and I are trying to get our insurance to approve him having an upper limited myectomy. Our primary care physician finally submitted a referral once we saw an opthamologist who wrote a letter saying that the upper limited myectomy would be beneficial for him. We requested that we see a Dr. William McLeish in Scottsdale AZ at the Mayo Clinic, since Dr Anderson had recommended him as a colleague and we figured that since it was within AZ, where we live we would be more likely to have it approved. (Although Dr Anderson would have been our first choice.) The opthamologist that we saw said she used to do the upper limited myectomy, but hasn't done one in several years since she now does botox and is probably not up to speed on the updated procedure. The problem now is that our insurance, Pacificare, denied our request to see Dr. McLeish or Dr Anderson and is going to send us to this opthamologist instead. The thing is that we called this morning and her staff had never heard of her doing the myectomy procedure and actually said that they refer people to Dr. Anderson in Utah. Then the opthamologist's office called us back and said that our insurance had called and set up an appointment for a consultation and they were now saying that the doctor does perform the procedure. I'm just concerned, because in the letter she sent to our primary care physician she wrote that we 'were not concerned with the possibilities of deformaties caused by the procedure'. I am concerned that she is not the one that should be performing this type of delicate procedure on my husband. I am concerned that the insurance is settling for the most convenient rather than the better trained physician. We would like to give her a chance, but we want to make sure that the procedure is done correctly. What kind of questions should we be asking when we go in for the consultation? Has anyone out there had the procedure done then had to go to another doctor, such as Dr. Anderson, to try to correct what the previous doctor did wrong? This is a very delicate procedure, isn't it? If she is not up to date on this procedure, if its not done right, can it damage him permanently so it can not be corrected? She has been to the conferences, so she has shown an interest. I don't want him to be used as her test subject to hone her skills on. My husband is very anxious about this and I'm concerned if he is not comfortable with this doctor doing the procedure that he will give up on the opportunity of having a shot at having any surgery. He is in pain constantly, if this is an opportunity to relieve some of the pain I want him to have that chance. Does any one have any recommendations on how we might get our insurance to approve seeing Dr. McLeish or Dr Anderson for the procedure? I would like to hear from any of you that have had the procedure done through Dr. Anderson. We really need to convince the insurance that this just isn't any procedure and they need to consider that money should not be a issue and that a person's well being should be a priority. Thank you very much. God Bless. --Lisa Elias |
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Re: Concerned wife Re: Concerned wife -- R Elias Top of Thread Archive
Posted by: June in Toronto ®
02/14/2003, 07:12:28
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Hi Lisa, I can't answer your questions - I have not had a myectomy nor do I live in the U.S. But I just wanted to say hello to you and Rolando (we haven't heard from you for a while) and to wish you the very best in your decisions. It certainly does sound like a convenience for the insurance company and I believe most people would suggest you only have the surgery done by the very best (Dr.A.). Maybe others will have some ideas for you on how to achieve this. God Bless you both.June in Toronto
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Re: Delaine - Alan - Virginia - etc. Re: Concerned wife -- R Elias Top of Thread Archive
Posted by: Sally - in - Idaho ®
02/14/2003, 20:49:37
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Hi Lisa,I remember you and Rolando from past postings. I cannot help with your questions, but will try to bump your message to the top so it will be seen. Shirley would be good for answers, but she needs time for her grieving process right now. Delaine or Alan could give concise answers to what you should make note of for the insurance.
Good luck.
Sally in North Idaho
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Re: Concerned wife Re: Concerned wife -- R Elias Top of Thread Archive
Posted by: Delaine Inman ®
02/14/2003, 22:19:43
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You certainly have a right to be concerned. Document what has been said or sent to you from the other doctors. Your best bet is to have your doctor write a letter to your insurance company referring your husband to Dr. Anderson because he has performed so many and is a leading expert on this very delicate and complicated procedure. You also write a letter stating your reasons why it would be in your husbands best interest to have an expert do the surgery so that there is less risk of complications in the future. You might even call and talk to Dr. Anderson's office and have them send you information explaining the procedure and why it needs to be done by an expert who has experience in the most up to date surgical techniques. Be assertive and persistent. Good luck.
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Re: Concerned wife Re: Re: Concerned wife -- Delaine Inman Top of Thread Archive
Posted by: Jeannie Day ®
02/15/2003, 21:14:06
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I agree with Delaine that you should document what the doctors and office staff have communicated to you. I wonder if the insurance company and/or doctor is willing to accept the blame(lawsuit) if the surgery is unsuccessful. Do you have it in writing from the doctor who said she didn't do this surgery any longer?Ohio-- Jeannie who is snowed in. Our little town got 10 in. of snow and the snowplow blocked our driveway with 2 feet of snow at the end.
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Re: Concerned wife Re: Re: Concerned wife -- Jeannie Day Top of Thread Archive
Posted by: R Elias ®
02/15/2003, 22:45:08
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Thank you, Sally for helping with suggesting who would be good to go to for information and thank you, Delaine and Jeannie for responding with some great advice. I will make sure to make note of everything and to get as much in writing as I can. I really appreciate you guys for the much needed support and advice you give. Thank you so very much. God bless. LisaShirley, Our thoughts and prayers are with you and your family. We are so sorry to hear of your loss. God bless you. Rolando, Lisa & the girls
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Re: Concerned wife Re: Re: Concerned wife -- R Elias Top of Thread Archive
Posted by: Ann Doyle ®
02/17/2003, 17:26:24
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Also have your DR. explain, if it isn't done by an expert the first time, it usually has to be done again eevery 3 to 5 years which would also increase the cost to the insurance Co. Ann Doyle
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Re: Concerned wife Re: Concerned wife -- R Elias Top of Thread Archive
Posted by: Virginia ®
02/16/2003, 10:56:09
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I have wondered how Rolando was doing since I met you two at the Arizona conference.I have been incredibly fortunate with my insurance, so may not be much help, but the first things I would do at the appointment that you have is to ask questions - things like:
How many myectomies has she done?
How often?
When was the most recent?
Will she supply names of recent patients for you to contact? (and then do it if she does give you names) You might even want not-so-recent names to find out if the procedure helped long term.
Has she done the procedure on others with the same "complications" as Rolando?
Where did she get her training?These were the kind of questions I asked when I was looking for a surgeon and I didn't have an uncooperative insurance company to deal with. But with the info you gather, you can decide whether to trust her or to go back to the insurance company to request another surgeon.
Good luck and stay in touch. It means a lot to have a caring partner to help deal with this stuff.
Virginia in AL
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Re: Concerned wife Re: Concerned wife -- R Elias Top of Thread Archive
Posted by: Marty Kiesewetter ®
02/17/2003, 16:22:03
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Lisa,
I had my myectomy performed by Dr A. over the holidays. I started checking on the insurance in October. It took Michele Bennett at Dr. A's office to send all the information regarding Dr A's credentials and the delicate nature of the surgery to convince my insurance to cover me out of the network. You can call Michele toll free on 877 844 3223.
I would consider that after 6 weeks of SLOW SLOW healing that the operation has been successful in keeping my eyes open. I just hope and pray that it lasts.
Call me if you want to discuss at 309 925 5086 evenings.
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