Off to Cleveland...

[mtlieb]

Hi All,

After speaking with Dr. Lever's office this afternoon, they've decided that this is serious enough to get me up there tomorrow morning. We need to get my CHF under control and evaluate me for myectomy once and for all. I'm excited about going. My local cardio has not been attacking this very aggressively, and i really need to see someone who knows what they're doing.

The real fun today has been trying to get everything squared away with my insurance company since Cleveland is out of network. My PCP won't call to get authorization for me, because he's not the one that has been treating my HCM. He says it's my cardio's job. My cardio's office doesn't want to call and get authorization for me, because they feel it is the PCP's job. After calling each of them a bunch of times to try and get it straightened out, both offices finally got irate with me and told me to stop calling. In the meantime, the insurance company warned me that if they don't get what they need up front, they ain't paying.

For the love of god... i'm in CHF here, and while my idiot doctors are arguing amongst themselves about who should get the authorization for me, i'm not getting any better

Anyway, thanks for letting me rant. I'll let ya know how everything turns out.

Jim

[Laoshur]

Re: Off to Cleveland...

Jim,

This is ridiculous! I suspect that your PCP has to do this, but regardless, this is awful.

I am so glad, however, that you are going to see the experts. I feel sure that sooner or later your current doctors will resolve their petty quarrels and you will go to Cleveland.

We will be eager to hear what they recommend and do and that you will soon be feeling much better.

Rhoda

[LynnS]

Re: Off to Cleveland...

Jim,

This is great news about your trip to CCF to see Dr. Lever! I'm so sorry you have continued to suffer w/ CHF but so glad that you have spoken with Lever's office and they have decided to bring you up immediately.

Be sure to let the office know about your insurance woes, they might be able to lend their assistance as well.

Be safe and keep us posted as you can, I am anxiously waiting to hear about things.

All the best,
Lynn

[Reenie]

Re: Off to Cleveland...

Jim, I'm praying you finally get some answers. Take care and know that I'm pulling for you!

Reenie

[mtlieb]

Re: Off to Cleveland...

Thanks Everyone,

I haven't even been to Cleveland yet and i'm already fairly impressed with Dr. Lever. The man actually called me personally to discuss my situation and get me in for an appointment tomorrow. I can't even get my PCP to do that! LoL.

Karen at Dr. Lever's office is great. She asked for the phone numbers for both my PCP and my cardiologist, and called them both to see what the heck the problem was with my pre-authorization. That girl kicks butt! Unfortunately, she wasn't able to get any further than i did, but it was cool that she wanted to try

Thanks again,

Jim

[Cynaburst]

Re: Off to Cleveland...

Jim - How are you getting there? Are you ok to travel?

I have my fingers crossed for you. I hope that Dr. Lever can provide the answers you have been looking for!

Best,

Cynthia

[felixdacat]

Re: Off to Cleveland...

good luck. sorry you are having problems with the referals. Our PCP
is one large group and they prefer to give referals. Its the only thing
they are really really good at , and who knew that is EXACTLY what
felix would need

I hope you get answers and feel better soon.

sandy (logged in as felix).

[shirleymahoney]

Re: Off to Cleveland...

Jim maybe your insurance company should step into this, but if it is an HMO it is your pcp doc that has to give the referral, even if your cardiologist want\ed you to go there your PCP would have to get the referral, i mean that is the way mine works anyway, everything goes through my primary care doctor

Good Luck Jim

Shirley

[Burton Borrok]

Re: Off to Cleveland...

As far as I know for my HMO anybody I see can give a referral, as I have gotten referrals from doctors assigned to me in the hospital. However the primary requirement for my PCP was that I could get any referral I asked for. As it turned out, she is also a great internist.

Jim, ask your insurance company for help in getting a referral STAT. Most companies take a few days to process them, “But you are in great need of treatment NOW.” Tell them you’re in CHF and have been sliding down hill for some time, and the Cleveland Clinic wants you there this morning.

Good luck, my friend. Please keep us posted.
Burt

[mtlieb]

Re: Off to Cleveland...

My cardiologist is back on my good-guy list again,

I got a call from him later this evening from his home, and the guy felt pretty bad about what was going on. In fact, i got the impression that the girls in the front office hadn't even told him that i was calling about this, and were just trying to 'handle me' themselves. I shudder to think of how often these kinds of things happen every day to patients. At any rate, he ended up calling my insurance company himself to get me authorized for the trip, but was told that the referral absolutely must come from my PCP, period.

He did however succeed in getting a case opened for me prior to the trip, and the insurance company has now documented in my records that both my local cardio and my specialist in Pittsburgh feel that it is medically necessary for me to be seen by Dr. Lever as soon as possible. Now all we have to do is get my PCP to sign off on it and submit the necessary paperwork, although that may be pretty tough since i'm leaving for Cleveland at 4:00 am and my PCP's office told me not to call any more regarding this matter

But at least we got the ball rolling, and my insurance company is aware of the problem. I'm going to try and get my contact at the insurance company to call my PCP in the morning and inform him of his obligation here. After all, it is my PCP who referred me to my cardiologist to begin with, and i believe he has some responsibility in following the treatment plan as recommended. Surely this must happen all the time, right?

Thanks,

Jim

[Sarah]

Re: Off to Cleveland...

Dear Jim

Call the insurance company and let them know that your PCP's office has told you not to call them anymore on this matter. Ask them if they can call --you know it is above and beyond, but they are refusing to do their lawful duty and are not listening to you.

If that doesn't work, call the PCP's office and let them know that they are in violation of the law, of their agreement with your insurance company and that they are required to give you a referral, your cardiologist is prohibited from doing it. If they can't, you will be notifiying the state insurance commission immediately. See if that gets their attention. then do it.

take care and tell Lever I said HI!

S

[mtlieb]

Re: Off to Cleveland...

Burton, Sarah, everyone...

Thanks for the advice regarding the insurance issues. In fact i'm going to call their 24 hour line right now and see if i can request that someone call my PCP first thing in the morning. At the very least, it will get another notation in my records prior to my trip that my PCP has been uncooperative with me. That way, everything will have been documented ahead of time, and as we all know, documentation is everything! I've kept very good notes on all of my calls, who it was that i spoke with, the date and time, and the outcome of the call. The insurance company will not be able to say i did not follow the proper channels.

Now if i could just get some sleep, but alas it is almost 3:00 am and i will be leaving for Cleveland in another hour or so. Like i told Cynthia and Lynn... i have a tendency to fall asleep during echocardiograms as it is! I'm sure i'll be snoring my way through much of the day tomorrow

P.S. I do have someone going with me so you needn't worry about me crashing on the interstate or anything.

Take care,

Jim

[Linda]

Re: Off to Cleveland...

Jim, Best wishes for the visit ahead. Glad you have someone with you. Please keep us posted. Linda

[swinand]

Re: Off to Cleveland...

Jim, All I can say is WOW!!! How can a Dr.s office with a patient in CHF REFUSE to even refer the patient to the right treatment. What a bunch of bozos. I'm sure once the Drs put their heads together and the bozos in the office get reamed hopefully things will be taken care of. Boy, one thing I can't stand is incompetence.
Anyway, glad you are FINALLY getting the treatment you need. Dr. Lever is a great guy and good Dr. You are in good hands. Pass on my regards to the good Dr. He got me straightened out in Jan. I haven't felt this good in years. Stay in touch with us all and let us know the outcome and your progress. I think you know where this is headed. Take care, Steve.

[angall]

Re: Off to Cleveland...

Hi Jim....I can't believe a medical professional, someone that has taken an oath, can be so heartless. What the heck is wrong with these people! You need the referral! Come on guys....get with it!!! If the reason the referral has not been given to you is because of staff, they shouldn't be there!! They should know the correct procedures and if in doubt, ask the doctor! This has me so confused I guess because I've never had a problem like this. Jim...I hope everything works out for you. Speak to Dr. Lever about what to do if this should happen again....he or his staff should have some suggestions.

Please keep us posted as to your progress. Sending my prayers.
Esther