Rough road ahead dealing with HMO, doctors and Insurance Co.
Journal posted on June 5, 2013
I should have had surgery 6 months ago, I was lucky that after waiting 6 months I was still strong as I was, my heart and lungs were strong but had a bad mitral valve and breathing was difficult.
I never had any experience dealing with medical insurance, had owned my own business and bought polices with high deductibles and paid everything to of pocket, now I was working for a company that supplied HMO insurance. I did not know a HMO from a PPO it was never a concern until I needed it. First thing,I am not an expert , will just tell about my experience.
Do your homework, don't take no as an answer, this is the most important thing I can stress. I had not done my homework as well as I should have out of ignorance and relying on the "experts".
Deep into my journey to find good medical care I found out too late that my insurance company rates the medical groups one to five stars, should have found a five star group. My first Primary Care Physician (PCP) I will call Dr. Medicine Lite, call him that because I never had my clothes off. He finds a murmur and said I have to see cardiologist immediately and proceeds to tell me about how far medicine has come and compares me to VP Dick Cheney. Go home thinking I am a dead man. A couple of week later I see cardiologist confirms murmur moderate mitral valve regurgitation, do a follow up in one year.
I am now in a medical group rated 2 stars, see new cardiologist a year later does a couple of invasive tests and confirms severe mitral regurgitation. After the second test he wants to do a TEecho, I said you did that test 3 weeks ago " I have no record of that" his reply.
I have no confidence in this doctor and he refers me to a surgeon . I will admit I went to see this surgeon not expecting much. I will call him Dr. Nutty Professor, he was dirty unkempt with a dump of an office. He made it sound as if he preferred to replace valve than repair as I wanted. I asked about minimally invasive surgery and said I should go to the Cleveland Clinic and have a lot of hoses coming out of me, now the battle begins.
I was not going to use this Quack.
Determined to find best hospital and surgeon do my research on line and make my decision and call insurance co. this is what I want to do, can't do that they say. Why not? there is a 30 mile rule, your PCP has to be within 30 miles of your home.
Start all over again, Find Loma Linda Hospital and a great surgeon now need a new PCP and cardiologist to get me to Loma Linda, Insurance rep says see these doctors and they will get you to Loma Linda. See new doctors and they send me back to Dr. Nutty professor , have got to get out of this crazy loop.
It was six months of day in day out fighting, always waiting for the next phone call that would end the battle, every time I thought we were making progress another road block was in our way. We got a call from insurance co, do you want to file a formal complaint against HMO and insurance co? All I wanted was the Surgeon of my choice, about 3 months later I got my wish. Was scheduled for surgery in three weeks, the longest 3 weeks of my life, interrupted by a visit to emergency room thought I WAS HAVING A HEART ATTACK false alarm.
It is now two weeks ago that I had my surgery, I feel good but realize it will take some time to get back to normal.
My goal was to have mitral valve repaired in a minimally invasive procedure, Dr Hasaniya made it happen.
After I got out of surgery they soon took out breathing tube, my first words were "he lied" my wife asks who lied, the doctor lied he said they would only shave a little bit.
In pre op the nurse pulled down the top of gown and says this is going to be a big job. I took 3 rechargeable razors to get the job done. I looked like a skinny Pilsbury dough boy.
Mitral valve surgery a piece of cakeHMOs and Doctors torture
Journal posted on May 29, 2013
I am about a year and a half late to this forum. I am a private type of person who does not tweet or facebook etc. Writing for me is difficult but if my experience can help just one person it is worth the effort. Reading my first lines of my story I may be hated by some who have already been down this road, if you are just about to start the mitral valve journey there is great hope.
After 6 mos. fighting with HMO and doctors I am scheduled for surgery on Wednesday May 22nd .
My surgeon Hasaniya MD and his team at Loma Linda University were fantastic as were all the nurses at Loma Linda. These are just wonderful people who show great respect for their patients.
Wednesday 9am being prepped for surgery.
5pm my first words "tube out" had read about the dreaded breathing tube. Felt real good, no real pain.
Thursday morning up and walking the halls, Surgeon stops by and said I can go home tomorrow if I am up to it, I am out of here.
Friday, did a lot of walking. All remaining tubes were removed. About 4pm I faced the most difficult challenge of my visit, was told I can not leave until a did a "#2"
(pooped) . Two hours later success, pack my things and gone. During my visit I struggled with that breathing device not getting more than 25%, While waiting for the wheelchair for my escape I gave that device another shot. Took a slow breath and max the thing out, what just happened must be a mistake. Try it again and max it out,It had to be adrenaline.
It is now Wednesday the 29th can walk the neighborhood no problem, would like to mow the lawn but my wife won't let me. Still using that breathing device but have built up to about 75% not the 100% I did a few days ago.
A couple of tips I would like to pass along to help breathing difficulties.
Bed Bath and Beyond sells a foam wedge that elevates head to make breathing easier, it can be used above mattress or below it.
I also found a hot mist humidifier at bed side also helps.
My real challenge was my dealing with HMO and doctors, I will cover that in future posts.