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HMO approval for Cleveland closer

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  • HMO approval for Cleveland closer

    [HMO approval for Cleveland closer]

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

    Date: 08-16-02 20:24

    I am finally getting somewhere with my local HMO. I have a case manager and

    I learned today that the local surgeon called the HMO and told them that with my unique situation I NEED to go to the Ceveland Clinic. Since this is the surgeon who would have done the surgery, that helps a bunch! Of course, the medical director still needs to make the final approval, but it is getting closer. I should know Monday or Tuesday. If approved, we are off to Cleveland on Wednesday for a cath and echo with surgery Tuesday the 27th.

    Thanks to all for the support and great Cleveland info. Lynn, (Tim), Dawn, if I do have my myectomy this month, we will all have to get t-shirts that say "I survived the Cleveland Myectomy" August 2002. That should get some weird looks.

    Jerry

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

    [Re: HMO approval for Cleveland closer]

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

    Date: 08-16-02 21:59

    Jerry -

    Great news - - but I think the t-shirt should say

    "Myectomy August 2002- -Cleveland - - Getting to the heart of the matter"

    and set it up like the old rock concert t-shirts

    keep smiling and best wishes!

    Lisa

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

    [Re: HMO approval for Cleveland closer]

    Author: Lynn S. (---.dsl.dytnoh.ameritech.net)

    Date: 08-16-02 23:15

    I love it!!! T-shirts would definitely be a great way to show off our courage and generate some local discussion about the disease too!

    Jerry - make sure you let us know what the final word is about everything. If you do have surgery on the 27th I can always send Tim to stop in later that week to say 'hello'! I'll be having my heart cath on the 27th there at Cleveland...who knows, maybe we'd pass each other in recovery...

    Hang in there,

    Lynn

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

    [Re: HMO approval for Cleveland closer]

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

    Date: 08-16-02 23:47

    Lynn,

    You guys still staying in Beachwood? My wife found a Marriott Suites out there for $99/night but she thinks it is too far out.

    Jerry

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

    [Re: HMO approval for Cleveland closer]

    Author: Dolly (---.proxy.aol.com)

    Date: 08-17-02 00:11

    Great news Jerry! I'm glad to hear that you are moving forward on this journey!

    I, too, have had good news. I have been accepted into Mayo Clinic. I'm waiting on the date. Now, just like you, I'm having to deal with the insurance company. I'm anticipating that my MD will be able to convince them to pay for the procedure (Myectomy).

    All the best to you, I'll keep you in my prayers.

    Dolly W

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

    [Re: HMO approval for Cleveland closer]

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

    Date: 08-17-02 01:32

    Dolly,

    Good Luck!

    Lisa,

    Thanks for the comments. It's hard to believe that I am getting excited about having open heart surgery!

    Jerry

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

    [Re: HMO approval for Cleveland closer]

    Author: Mary Sharp (---.proxy.aol.com)

    Date: 08-17-02 09:39

    You know this actually sounds like were applying for college or something here! I know for me it is just about as stressful trying to get the letter of approval for a specialist! I'm glad you guys are getting the help you need!

    Mary S.

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

    [Re: HMO approval for Cleveland closer]

    Author: Dawn (---.cl.ri.cox.net)

    Date: 08-17-02 09:54

    Hi All,

    Sorry I didn't answer sooner, working lots of extra shifts---I'm very tired.

    Jerry, glad to hear things are going in the right direction for you. I had a good laugh about the T'shirt. My mom's surg was not scheduled right away, they wanted to but couldn't. Mom was too freaked out (phobia of doc's/medical) and they wanted her mental status under control. So her's is around a month after they told her she needed it. Not too bad.

    Her surg is the 22nd, less than a week. I'm looking forward to mom feeling better (both HCM and mental). But right now, as I think about how fast the days are going, I've got a ton of butterflies in my stomach! And I'm not the one getting the surg!!! Lynn, Jerry--I give you lots of credit for keeping positive and calm.

    Tim, it sounds like the hotel situation is under control. It meets all of your needs. Plus you've been there before and know the area a little. Ruth is the east sider, I know very little about that side of town. (I can get to the Beachwood mall! My mom and daug LOVE to shop!)

    If any one is at the clinic on the 22nd---you'll find me keeping my dad company while he chain smokes from nervousness!! (Great, I just quit July 1).

    I still have three more 12 hour nights at work--14 in a row--not sure if I'll make it back to the computer. I wish you all lots of luck!

    Time for sleep,

    Dawn

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

    [Re: Cleveland Hotels.]

    Author: Tim S (---.dsl.dytnoh.ameritech.net)

    Date: 08-17-02 10:19

    Jerry,

    I have become quite the expert on Cleveland Area Hotels - Just ask my wife! Where to stay really depends on what is important to you (and/or your wife). For us, we were looking for something close to shopping, restaurants, and parks to give my mother and daughter something to do. However I may end up staying in the Guesthouse for the bulk of the visit for due to its proximity and for the free parking at the Clinic.

    Just for stats, here are some of the area hotels we considered:

    - Holiday Inn Select-City Centre (Downtown) $65.00/night ($12/night parking)

    - Holiday Inn Cleveland East (Wickliffe) $79.00/night

    - Clarion Hotel Cleveland East (Wickliffe) $62 - $82 / night

    - Holiday Inn Beachwood OH $101.15/night

    - InterContinental Hotel Cleveland Clinic $139/night ($12/night parking)

    - Guesthouse - Cleveland Clinic $89/night (free parking)

    There is also a Hilton, Embassy Suites, Ramada and others at the Beachwood exit.

    With all the hotels, it is worth calling them directly and asking if they have a Cleveland Clinic rate. You might also want to call the Travel Agent office at the Cleveland Clinic to see if they have any more suggestions.

    The drive to the clinic from Beachwood is a straight shot on surface streets. It takes you thought some nice scenic neighborhoods and there were only a few blocks near the clinic where we made sure that the doors of the car were locked. We traveled that route during 5pm rush hour traffic a few times and it took 20-25 minutes to drive - not bad at all.

    We had considered staying in Wickliffe this time but realized that an early morning trip to the clinic might be difficult as the route takes us on a major highway which (we have been told) may offer morning and evening delays. The same could be said of other west side locations. Therefore, we may opt for the Beachwood hotels again.

    Feel free to send me an email directly when your plans are solid for your week and maybe we can stop by and say HI! I’ll definitely have my laptop with me so I can update others as to Lynn’s progress.

    Thanks, Tim

    BTW, who is designing the T-Shirts?

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

    [HMO approval / Hotels]

    Author: Sue Harry (---.58.233.113.Dial1.Tampa1.Level3.net)

    Date: 08-17-02 21:14

    Hello! I am happy to report I also have good news as relates to getting approval from my HMO for a trip to Cleveland.I was denied referral with my first request. Since I last communicated with Lisa and Jerry I had some intervention by a concerned C.E.O. of the health facility where I have worked for 28 years. I have been told to go ahead and make my apt. with Dr. Asher or Dr. Lever at the Clinic. I would appreciate any suggestions anyone would care to pass on related to this process. I am going to call them on Monday. Since I live in Florida I am wondering if I will go up for an initial appointment and tests then return later for whatever procedure I need. Or would they do it all during one visit. I suppose it depends on my pre- testing results. It truly sounds like I need a myomectomy from what I know at this point.

    Tim, many thanks for the hotel information. I may be by myself for the inital visit. Also I will be flying up so I think I would want to stay as close to the Clinic as possible. Sounds like this Guesthouse might be best for me. Any other comments on this?

    Sign me up for a T-shirt!!

    Sue

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

    [Re: Hotels - Guesthouse]

    Author: Tim S (---.lexis-nexis.com)

    Date: 08-17-02 21:29

    Well after all that work on compiling information on area hotels, we have made the decision to leave our 2 1/2 year old daughter at home and stay at the guesthouse the entire time. If you are up there at the same time, you will know who I am 'cause I'll be the one wearing the "Myectomy Supporters" T-Shirt

    - Tim

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

    [Re: HMO approval / Hotels]

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

    Date: 08-17-02 21:30

    Sue -

    If you wish to minimize your trips call the office and let them know what is going on. If you have a gradient of approximately 50mm or greater and have not had relief with drug treatment then you may wish to evaluate myectomy or ablation as options. Let them know whats on your mind and ask if you can send records in advance along with a letter from your current doctor with his recommendation (if he has recommended a procedure). If they can do that they at least have an idea of what to expect when they see you and therefore try to fit it all in so that you need only go up there once.

    I have to get someone to work on this t-shirt thing! should we make up one t-shirt design on the back...and on a pocket in the front say "I had a Myectomy!", "I had an Alcohol Ablation with 100% pure Alcohol", " I have an ICD..and I keep on tickin'" and a general " I have HCM - ask me what it is" - and if the HCMA made these up...what should we charge??? it is a good idea for a fund raiser..and a good laugh.

    Looking for ideas here guys....

    Lisa

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

    [Re: HMO approval / Hotels]

    Author: Sue Harry (---.58.233.113.Dial1.Tampa1.Level3.net)

    Date: 08-17-02 21:46

    Thankyou for the quick response. Lisa, your suggestions over the phone made a world of difference. I read your other note. I hope you are feeling better. Boy, do I understand how stress can affect the HCM! Also since I have been losing weight everyone says how good I look. If they only knew how lousy I feel sometimes.

    One other question. Because of my insurance situation will they want to see it writing that I have an okay or will they go ahead an set up an appointment? Even though my appeal is not officially going to the committee until Sept 4 my C.E.O. would probably give me something in writing to verify coverage if I need it.( In case you don't recall my employer has its own HMO with a 3rd party administrator.)

    Tim, thanks for your additional input on the guesthouse.

    Thanks to all ------ Sue

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

    [Re: HMO approval / Hotels]

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

    Date: 08-17-02 21:57

    Sue - I would not worry about it for setting up the appointment. They will contact the ins. co but you will have at least a few weeks to get everything together with the ins before you get to Cleveland.

    If you are self ins. then the plan administrator can also write a letter requesting an ammendment to the plan - the trick here is that the "stop loss" carrier (AKA the reinsurance plan) must except the ammendment to the plan document or your employer will not have any coverage for your claims should they exceed the plans stop loss amount. Most of that is likely GREEK... But it is the "lingo" of the self ins. market (and what I spend a great deal of my "real" job doing).

    I am just telling you how the system works so that if you have any problems you understand where the buck stops...and that is with the stop loss carrier.

    Good luck..sounds like you will be fine!

    Lisa

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

    [Re: HMO approval / Hotels]

    Author: Reenie Smith (---.snbrca.adelphia.net)

    Date: 08-17-02 22:08

    Guys, if you are really interested in making up t-shirts, let me know. My sister in law owns an advertising company and she does shirts like these all the time. I would need to know quantity, how many colors of ink, and other stuff like that. I would love to help you get a price if you are interested in my checking on it.

    Reenie

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

    [Re: HMO approval / Hotels]

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

    Date: 08-18-02 01:53

    Sue,

    I am doing the Cleveland thing in 2 trips. I had approval for the consult, but even if you don't that is not that much, probably less than the airfare from Tampa. I did send Dr. Asher my records and he called me before we went. He basically told me if I knew what I wanted he could set-up appointments before I got there. I waited until then because of the insurance issue.

    If I do get approval, they have set everything up already. I have tests next Thursday and Friday. I meet with the surgeon and anathesiologist (?) Monday and the surgery is Tuesday. I would say one trip, but we are coming back for the weekend. We have an eight year old birthday party to run. No way I'm missing that!!

    I suggest that you try and get the HMO to do the consult and an echo. Set that up and then see what they say.

    Lisa, I hate saying this, but as helpfulas the insurance people were, they also needed help. Since I have a local HMO they were lost on exactly how to proceed. They did make calls to try and find out and we did work it out, but I had to intervene a bunch.

    Jerry

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

    [Re: HMO approval / Hotels]

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

    Date: 08-18-02 01:56

    Tim / Lynn,

    Any specific reason why you decided on the guest house. Also, do you know if they transport to the hospital?

    Jerry

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

    [Re: HMO approval / Hotels]

    Author: Tim S (---.dsl.dytnoh.ameritech.net)

    Date: 08-18-02 09:41

    Jerry,

    Originally when we thought we would bring our daughter with us, we were concerned about providing activities for her and my mother. However, after receiving Lynn's scheduled from the Clinic, it was apparent that Lynn is going to be very busy with testing and appointments each day. Because some of the appointments could be early in the morning, location was a factor. Also because we will be driving up (4 hours from Dayton), parking was an issue.

    We finally reluctantly decided on the Guesthouse due to it’s proximity to the clinic (across the street) and the free parking during our stay. They are not the cheapest place to stay but when you factor in the parking and location, it just makes sense. Although I may miss the hot-tub and other hotel amenities available elsewhere, I will not complain about NOT having to drive a distance every day - especially since I may be up there a while (10-14 days).

    The Guesthouse offers kitchenettes in some of the room (for a higher price) in the event you are interested in cooking meals during your stay. However, I will probably just rent the basic room (which includes a refrigerator and coffee maker) for my stay. The hospital cafeteria is across the street and offers decent food at a reasonably price. Since I will have my car I can also seek out food when I am tired of the cafeteria.

    The clinic does run a free shuttle service around the campus to provide transportation to the various buildings. However since the Heart Hospital is just one block away, the walk will be a welcomed diversion during the week.

    Good luck to you during your visit, we’re very hopeful that you will get your approval! Maybe we will see you there!

    - Tim

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

    [Re: HMO approval / Hotels]

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

    Date: 08-18-02 10:40

    Reenie -

    I posted under the T-Shirt topic to let me know who has contact in the business...can you have your sister call me at the HCMA office - Thanks!

    Jerry - Yes Ins. co's need some hand holding I agree 100% however Sues Ins. plan is a little different then a "traditional" plan therefore the rules are a bit different.

    Tim/Lynn - Boy you are a wonderful planner... you thought of everthing!

    Best of luck to ALL!

    Lisa

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

    [Re: HMO approval / Hotels]

    Author: Linda (---.wmnsmd.adelphia.net)

    Date: 08-18-02 13:37

    We had a stay at the Guest House a few years ago. It was very convenient, easy walk, free parking, and laundry facilities. There is a Rite Aide beside that is very well stocked, not just drug store, but mini-market as well. In the hospital, there is a McDonalds and a Pizza Hut. The convenience is well worth it. Best wishes to all. Linda

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

    [Re: HMO approval / Hotels]

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

    Date: 08-18-02 14:53

    Linda - - How is Mom??
    NOTE: This is a post from the previous forum message board.

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