I have certainly read news reports about other doctors out there who refuse to take insurance. But what that means depends very much upon the insurance company. Rosemary, your sister has a contract with the insurance company that they will pay for medically necessary medical procedures. When the doctor fills out forms, calls insurance companies, etc., he is acting as an agent for the patient. The agreement is that the insurance company pays for the procedures, and the role of the doctor is to assist the insurance company in collecting the information they need to pay the claim. There should be no reason why YOU can't act as your sister's agent with the insurance company. This would mean that you would have to research the insurance company rules and regulations. And you would have to research what the surgery entails, and how long it is expected to take, and why it is going to cost what it costs. Basically this means that you need to fill out all of the forms yourself after you collect enough information. Some of that information you can research online or at a medical school library. Other information will come from the doctor. If your sister is a doctor's patient, then she has the right to understand any procedures that doctor is going to perform on her. Most of the information that you would gather for an insurance company would be taking information from the doctor and giving copies to the insurance company. The wrinkle here is that a typical reimbursement rate for an adhesiolysis surgery is like $2500, while the surgery (when done by a surgeon who knows how) costs $15,000 to $50,000. In order to get the insurance to pay for an adhesiolysis for your sister you are going to have to do lots of research, and fight, and lose, and appeal and lose again, and appeal until you get to the highest levels in the insurance company. You need to understand that you are absolutely in the right here. If your sister had a heart attack and needed bypass surgery and the bills were $50,000 or $75,000 or $100,000 then the insurance company would pay up without a second thought. These companies think that because there are so few of us out there with adhesion problems that they can just tell us to go f*** off when it comes time for them to live up to the agreement that they made to pay for procedures that are medically necessary. And saying "Oh, we can only go to a doctor that will do the surgery for $2500" is just not acceptable. Suppose your insurance company suddenly decreed that they would only pay $5000 for a heart bypass. You wouldn't say, "Oh, well, I suppose that means that I have to have a quack do the surgery, because only a quack will do it for that price."
If you are unwilling or unable or unsuccessful in taking on the insurance company, then there are a couple of other options. One is to go to Germany and have surgery with Dr. Korrel and pay for it out of pocket. This has 2 advantages -- most importantly, he can use spray gel, which does not have FDA approval. The other advantage is that the whole trip, surgery, hospital care, etc. will cost in the $5000-$7000 range (depending on the exchange rates, good airfares, etc) thanks to that hefty subsidy from the German taxpayers to the German health care system. To raise money for either a Germany trip or surgery in Pennsylvania I basically see 2 options. You can have fundraisers -- people are often quite charitable. And you can sue the doctor(s) who have done the surgeries that have gotten your sister into this mess.
Good luck, and your sister is lucky to have you on her side!
At Thu, 6 Jun 2002, Rosemary F wrote:
>
>I've written to this message board about 2 weeks ago and was told a Dr.
>Reidan and Dr. Reich. I'm looking for a doctor for my sister.
>Unfortunately, when she called Dr. Reich and was told that not only
>doesn't he accept any insurance but that he would not even fill out an
>insurance form, my sister absolutely cannot afford to see him. I guess
>I have a problem understanding why a doctor would not fill out insurance
>forms. In any case, I'm still looking for a doctor to help my sister.
>Her current doctor really doesn't want to treat her. She's home from
>the hospital now but still cannot hold food or even liquids down. She's
>constantly in the bathroom. My entire family is very concerned. Her
>current doctor admits there's a blockage but he does not want to operate
>right now.....he also does not want to do anymore laparscopic surgery as
>he's afraid he's going to puncture something (does this make sense????).
>So as we stand now.....no surgery...no eating...constantly in the
>bathroom....
>Does anyone know of another doctor who treats patients with severe
>adhesions. We live in the New York area and will travel anywhere in the
>northeast. Any information would be most appreciated.
>
>Rosemary
-- cathy :-)