It just hit me.....I have Medicare as my primary and Blue Cross Blue Shield as secondary (even though I do not pay supplemental rates)!!! Maybe that answers some of the questions as to why I have been refused care at so many places! Mayo Clinic is the worst! They wouldn't accept assignment of benefits there so I still to this day have a bill there. When I was in an emergency situation they refused to accept me there unless I had a $2500 deposit and my bill balance...which is a whole $500.
I don't care what it takes....I will be going to see Dr. Reich and Dr. Redan....even if it means doing 10 fundraisers!!
My heart went out to you when I read of your trials with the gynecologist....I felt like you and I were in the same boat, but know that there is help out there....we just need to find it. I pray that you can get out to Dr. Reich....and that I can have my surgery SOON and get out to Dr. Reich soon afterwards.
God Bless You.
Karla
Karla
> [ I decided to re-post my message, because I find it difficult to read
> messages which extend beyond the space, which is allowed for them to
be
> written. ]
>
> [] I have deleted a good share of Bev's adhesiolysis experience
because
> I wanted to focus on the issue of how medical insurance ( in my case
> Medicare and supplemental insurance) can affect the way that doctors
and
> surgeons choose to do business with their patients.
>
> At Sat, 20 May 2000, Bernie and Beverly Doucette wrote:
>
> [] MONEY AN ISSUE? INSURANCE AN ISSUE?
>
> " Because insurance company's across the USA have set rates ( ceiling
> rates ) on most surgical procedures...and they set a rate for that
> procedure based on what they think it SHOULD cost...so in a normal "
> Adhesiolysis " procedure, the usual rate across the board is about
$2500
> total! Now that means that no matter who the surgeon is, or the
facility
> where it is performed in, the insurance company will pay no more then
> that amount...no matter how long the procedure is, no matter how
skilled
> the surgeon or reputation of the surgeon, that is the amount they pay
as
> that is what they feel that particular surgery should cost. That rate
> is based on the amount of time and the " importance " of the
> adhesiolysis procedure.
>
> " Most insurance company's feel that an adhesiolysis procedure SHOULD
be
> able to be performed in about 1.5 - 2 hours TOPS!!! Why? Well, as you
> know, MOST surgeons and DR's do NOT feel that adhesions in and of
> themselves are a disease or cause a problem...unless you obstruct...so
> it is their impression that a surgeon should be able to go in,
> laparotomy or laparoscopically, and simply slice them apart...but they
> also feel that it should be or is usually done in relationship to a
> cooperative surgery such as a hysterectomy, appendectomy or some other
> type of surgical procedure...and if you look and listen to other ARD
> sufferers, there has always been another reason or procedure done when
> they had an adhesiolysis...know why? Because the surgeon gets more
money
> by performing another procedure with the adhesiolysis!! When they do
a "
> diagnostic " procedure ( which is their way of being able to perform
an
> adhesiolysis only ) they get paid very low rates for their time...and
> adhesions take time...so most Dr's do the 1.5 - 2 hour adhesiolysis
and
> then close you up or take out an organ or do a resection etc.!! Not
only
> will they not do a good job, but the hospital will not allow any more
> time for one as the money paid from the insurance companies is not
> enough to compensate for the use of the operating room, the
> anesthesiologist's time, etc...so everyone loses, mostly the ARD
> patient!!"
>
> - - - - - - -
>
> [] MY ADHESIOLYSIS EXPERIENCE:
>
> I want to share the experience I had following a diagnostic
laparoscopy
> in 1997:
>
> After 27 years of seeing doctor after doctor after doctor...I finally
> found a gynecologist, who listened to me and sincerely believed that I
> was suffering from chronic pain. He told me that, from the
description
> I gave him about my symptoms, to him my symptoms sounded like either
> adhesions or endometriosis...but he felt pretty sure that adhesions
were
> the cause of my pain. He told me that only a diagnostic laparoscopy
> would provide the answer. This was the very first time I had ever
been
> offered a diagnostic laparoscopy!!!
>
> So on August 1, 1997 I was scheduled for Same Day Surgery at a
hospital
> in Minneapolis, MN. At the very beginning of this surgical procedure,
> my gynecologist had great difficulty in inserting the laparoscope
> through my navel, the usual first point of entry. Instead, he had to
> start the procedure just above the pubic bone.
>
> What was the result of my diagnostic laparoscopy? I had massive
> adhesions the full length ( 7 inches ) and 4 inches across the
surgical
> incision from the laparotomy I had undegone in February 1970!! These
> massive adhesions had attached my omentum ( The omentum serves as a
> protective barrier between the intestines and the abdominal wall. )
to
> my abdominal wall...almost as if my omentum had been super-glued to my
> abdominal wall!!!
>
> I requested a copy of the video of my surgery; which really proved
what
> my surgeon was up against. I watched the video and I was able to see
> the difficulty my surgeon was up against. Remember, this was a
> diagnostic laparoscopy...and he had to lyse these tough adhesions (
They
> were very mature because they were 27+ years old! ) before he could
> begin his examination of the rest of my pelvic organs.
>
> As he cut through these adhesions with the use of scissors ( which cut
> and cauterize at the same time ) I noticed that as a result of the
> cauterizing, the liquidized fat dripped into the pelvic cavity. I do
> not know if this substance is irritating to the pelvic organs;
> BUT...just before the surgeon freed the adhesions from my abdominal
> wall, I saw a really thick adhesion, which had a blood vessel running
> through it. When he cut through it, I noticed that it bled...causing
> blood to drip into my pelvic cavity. Blood is a known irritant, which
> can cause scar tissue or adhesions to develop.
>
> Because of the massive adhesions, I was kept in the hospital
> overnight...on intravenous antibiotics and pain medication. Other
than
> the expected pain from surgery, I definitely felt better than I had
in a
> long, long time ( 27 years ). I had such great hopes that I would be
> pain-free......UNTIL on the 10th day I began to feel the return of
pain;
> but I did not get too concerned about it. Six weeks post-op I
mentioned
> this to my gynecologist...but he did not show any real concern. Not
> being a very assertive person, I did not make an issue out of it...
>
> ...until several weeks later when my pain level was beginning to get
out
> of hand. Since I lived at some distance from Minneapolis, I wrote to
my
> gynecologist to ask what he would suggest that I do...actually
thinking
> that I would be given an appointment date. Two weeks later I
received a
> call from one of his office nurses. She said, " No, the doctor did
not
> want to see me!!" I asked if I could make an appointment...but again
she
> said that the doctor did not want to see me. I was
shattered!!!!!!!!!!!
> I could not understand why this gynecologist wouldn't see me.
>
> It took me almost 6 months to find out why I had been refused further
> care from this gynecologist!!! During those 6 months I spent alot of
> time on the Internet...participating in the Endometriosis Forum (
> http://forums.obgyn.net/endo/ ); because I needed a place where I
could
> vent some of the frustrations and feelings that had come over me as a
> result of being denied care by my gynecologist. It was through this
> forum, that I learned the answer to the "cold shoulder" I had been
given
> by my gynecologist's nurse ( who was acting in behalf of my
> gynecologist.)
>
> This is what I learned: Because I am a Medicare patient - with
> supplementary insurance. Medicare did not pay
> what my gynecologist was asking!!! My gynecologist had to accept what
> Medicare and my supplementary insurance paid him...and then my
> gynecologist had to " write-off " the
> balance. In other words he did a difficult surgery but was not paid
> adequately!! I know that the same thing happened for both the hospital
> and the anesthesiologist - both had to be satisfied with what Medicare
> paid them. Neither the gynecologist, the hospital, nor the
> anesthesiologist could bill me for the unpaid balance!!!
>
> Another thing I learned was that there are certain hospitals in the
> United States which WILL NOT ACCEPT MEDICARE PATIENTS!!! That's
right!!!
> The low payments, which Medicare reimburses doctors and hospitals
with,
> is intended as Medicare's way of protecting seniors from excessive
> medical charges...which , unfortunately, prevents seniors from seeking
> the very best professional care.
>
> So I can understand why many doctors do not do diagnostic
> procedures...but rather look and wait for another better-paying
surgical
> procedure to arise.....SUCH AS HYSTERECTOMIES...and many
hysterectomies
> are DONE FOR THE WRONG REASON!!
>
> I read an interesting book by the name of " Women and
Doctors "...which
> was written by a male gynecologist. What I found really surprising
was
> that this male gynecologist was actually advising women to seek
medical
> care from female gynecologists...rather than from male gynecologists.
> His reasoning is that female gynecologists understand women and their
> medical problems far better than male gynecologists do. When in the
> care of a female gynecologist, women can avoid certain male
> gynecologists who may "prey" on women by suggesting surgical
procedures,
> such as hysterectomies, when a hysterectomy is not warranted at all.
> Don't let this happen to you!! Learn as much as you can a medical
> problem, which you may have; and consider seeking second opinions
before
> undergoing the knife!!
>
> [] NOW, CONTINUE ON WITH BEV's MESSAGE:
>
> " Now, by asking for the $3000 up front in Scranton, this assures that
> in the event the insurance company doesn't pay for a lengthy
> adhesiolysis procedure if your very involved with adhesions and the
> surgery takes 4 - 10 hours, and trust me, they will not pay for
> that...then DR. Redan, or Dr. Reich have at least been compensated
for
> their time, skill and expertise in lysing adhesions. If your surgery
is
> within a " normal " range of time, and all the pre-payment is not
> utilized, you get all or some of it back. I had a 5 hour surgery, and
> was refunded a decent portion of it after my surgery! The $400
> consultation fee is just what you pay for the experienced specialist
if
> you want them. A person wouldn't think twice if you were talking open
> heart surgery...you would go to and pay for the best Dr. in the world
> if it meant your life, right...well this is your life too, it is just
> that it is under-rated as a problem unless you're the victim of ARD
> (Adhesion-Related Disease)!! Money spent is scary, sure, but money is
> nothing without the life to spend it on!"
>
http://www.adhesions.org/forums/listcmds.htm
>