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  • HMO ****!

    [HMO ****!]

    Author: Jerry Salzman (---.indy.rr.com)

    Date: 07-01-02 21:38

    Hi All,

    Here is the latest. I have seen the local Ablation Cardiologist and the Cardio-Torastic surgeon who does myectomies. While both are great people and I am sure outstanding doctors I do not have that warm and fuzzy feeling with either one. It just feels like they do not have the experience. For example, Lisa has mentioned that I try other drugs that I know others have tried. All I have had is attenenol, and my cardiologist says there are no other medications which would work better. The surgeon I asked if I had a TEE echo, no one ever mentioned that before. Finally, I asked what my septum width was, and looking through the records, the surgeon could not find it.

    Any ideas on getting the HMO to pay for a trip to a specialty center would be appreciated. My primary care doctor is going to ask, I am waiting for him to get back to me. By the way, changing insurance is not an option until January, and I do not think I can wait that long. My symptoms are getting worse, trying to work is becoming very difficult if not impossible.

    Thanks

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: HMO ****!]

    Author: Lisa Salberg (---.dyn.optonline.net)

    Date: 07-01-02 22:00

    Jerry -

    The first step is getting your primary dr to request the referal. They listen to the primary dr ...I would say 80% of the time...IF NOT you have options under that patients bill of rights. So lets try the referal 1st IF it fails then we will worry about the next step...

    Try to stay optimistic... I know we HMO bash from time to time here on the board...but lets give them a chance to do the right thing...we may be suprised!

    best of luck,

    Lisa

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: HMO ****!]

    Author: Board Moderator--Sarah Beckley (---.dsl.mindspring.com)

    Date: 07-02-02 00:44

    Dear Jerry

    I think that the fact that your cardiologist doesn't even know about or think about trying anything stronger than atenolol is big evidence that you need a different doctor and if you do end up needing to fight to get the referral OK from the HMO, that will play in your favor.

    really, atenolol is not the big guns at all. Amiodarone, disopyramide and dofetilide and sotolol are the upper tiers of medication therapy --and with the exception of sotolol -most people take one of them in addition to a beta-blocker.

    good luck and keep us posted.

    S

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    [Re: HMO ****!]

    Author: Jerry Salzman (---.treas.gov)

    Date: 07-03-02 16:29

    Hi All,

    It looks like I was wrong, my HMO is approving a consult at the Cleveland Clinic. I am going to see Dr. Asher on August 7th. Lisa you were correct.

    Jerry

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    [Re: HMO ****!]

    Author: Lisa Salberg (---.dyn.optonline.net)

    Date: 07-05-02 12:05

    Jerry,

    Great news I am glad your on your way to a center that can handle your evaluation!

    Best of luck and keep in touch!

    Lisa

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: HMO ****!]

    Author: john jordan (---.public.svc.webtv.net)

    Date: 07-05-02 14:49

    hi jerry, glad u will have consult. i will see dr. asher on july 10th, dr. smedira in july 11th and myectomy on july 16th. i hear praise for both as well as cleveland clinic. good luck to you, john

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: HMO ****!]

    Author: Jerry Salzman (---.indy.rr.com)

    Date: 07-06-02 10:30

    John,

    Thanks for the info. Good luck on your surgery.

    Jerry

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: HMO ****!]

    Author: Suzanne (---.stic.net)

    Date: 07-08-02 23:45

    Does the current cardiologist have to recommend to the PCP that the referral be made? I am a nurse and casually mentioned to a partner of the cardiologist that our family sees that I was interested in seeing a particular specialist. The partner stated that our doctor would probably be relieved to have a specialist see our son, in particular. I never thought of it that way... more worried about damaging the good relationship we've developed or making him feel like his opinion and treatment plan will never be adequate unless he offers drugs, a defib, or surgery, etc... What's really important is finding the best care and having no regrets later.

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

    [Re: HMO ****!]

    Author: Lisa Salberg (---.dyn.optonline.net)

    Date: 07-09-02 10:10

    Referrals need to be made in accordance with your insurance policy - however if you are not seeking reimbursement then you can make your own choice.

    This is the case in the USA - Canadians,,, your in a different situation as is the UK.

    I would say that in our experience Suzanne’s situations is the most common... relief from the local doc that someone else is helping manage the patient. While good relationships are important.... you can not risk your own care for fear that you are going to hurt the feelings of a medical professional... they are tough enough to take it

    Best to all,

    Lisa
    NOTE: This is a post from the previous forum message board.
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