Gordon Grigg…scheduled for release 9/29/2014.
The WordPress.com stats helper monkeys prepared a 2013 annual report for this blog.
Here’s an excerpt:
The Louvre Museum has 8.5 million visitors per year. This blog was viewed about 130,000 times in 2013. If it were an exhibit at the Louvre Museum, it would take about 6 days for that many people to see it.
Last entry (Part 9) Mayo Clinic fumbles the preverbial ball – but what an awesome recovery! Now we get the full picture and to be clear the process will be shared since the issue is NOT the Mayo Clinic, but obstinate Health Insurance Companies that seem to think they know more than my doctor. Arrrgggg!!!
NEWS on the MAYO FRONT!
To which I responded:
Diane (Dr Kwon’s nurse)…thank you for your email. It seems I am stuck between two competing factors – National Imaging Associates and the Mayo Clinic Urology. I cannot get my insurance company BC/BS to approved the C-11 that pre-certification comes through National Imaging Association. They won’t approved without a peer-to-peer discussion. Mayo Urology won’t do a peer-to-peer. PATIENT IS CAUGHT IN THE MIDDLE. Seems that sucks for the Patient (me in this case). Therefore, I respectfully request that someone with clinical knowledge do the peer-to-peer so that the C-11 can be approved. We both know that a pelvic MRI is likely (with a PSA of 1.1) to show nothing just like the CT scan and Bone scan. Happy to have the MRI done, but if that improves the approval of the C-11 scan great…otherwise seems it is a waste of time. National Imaging Association won’t consider a new application for the C-11 – they (according to your pre-certification dept) are only willing to reconsider with a peer-to-peer. I DO UNDERSTAND the time associated with this request. However, if it were you or your husband and there seems to be a stand off taking place that holds the patient (me) from getting what we both know I need, I’m sure you would agree that I have to ask. I am not asking that Dr. Kwon do the peer-to-peer, but do believe that there is someone in urology that is capable of convincing the physicial (likely retired and sitting on his ass with National Imaging Association) with NIA that a C-11 is the only thing that is likely to identify the location of my recurrent Prostate Cancer so that an effective treatment can be administered. I really appreciate your willingness to consider my request and hope that it falls on willing ears. Honestly that would be the best Holiday Gift I could receive – a yes from NIA. Thanks and hope your Thanksgiving was a blessing. Chuck
There is a simple saying – “You’ll always miss 100% of the shots you don’t take!” In other words you can’t get a “Yes” without asking. Me…well I am all about asking and more than once! Sales motto – ask until you get a “Yes” of piss them off trying. Either way you’ll get the outcome you desire or know that you’ve done your best trying!
Then later today a Mayo Clinic response – BETTER THAN EXPECTED!
Oh my…certainly better than expected. Dr. Kwon is the man when it comes to C-11 Pet Scans…so if anyone can convince National Imaging Associates of the value to me, he is the one that can do that!!!
THANK YOU! And the process continues!
Some posts are simple and don’t require many words.
Mayo Clinic Urology dept… well it started at 100% and I can honestly say they are good – real good – but when it comes to patient first or process and time – patient loses if they pay with insurance.
Let me explain. National Imaging Association denies the C-11 Pet Scan which would be the most likely test to determine the source of my recurrent prostate cancer. What they require is a Peer-to-Peer consultation with the folks at the Mayo Clinic.
Why? Likely because this particular Pet scan is so highly specialized that the NIA folks need to be “convinced” (my word) that its useful in my case. To be fair, Dr. Kwon, through the Mayo pre-certification dept sent extensive material to help them understand. Do I think the folks at NIA read it – na…not a chance.
But the problem is – Dr. Kwon and the Mayo Urology folks don’t (won’t) do peer-to-peer consultations with insurance companies. I was told if they did that is all they would do and therefore get no scans done.
Wait a minute…time out. You’re telling me that you (the Mayo Clinic) can’t hire someone with clinical urology experience to handle the interaction with insurance companies so that patients (like me) don’t get caught in the health insurance circle of death?
Sorry, but it is unacceptable that no one with enough specialized knowledge from Mayo Urology can take the time needed to do the peer-to-peer knowing that this test is “the” test needed to help me get appropriate direction needed for an effective treatment.
One call, but the Mayo Clinic won’t make that… at least that’s what I have been told for two days. So much for the patient coming first. Remember I (your patient) didn’t create this screwed up system of health care or payment system. I just need cooperation so I can move forward to eliminate this disease once and for all.
You sure you won’t make the peer-to-peer call? Please!
My dear friend Mary Auda has bravely stepped to the forefront and is sharing her process of healing from Sexual Abuse. One in three women encounter some form of sexual abuse…so feel free to follow Mary’s blog posts and perhaps it will help you on your journey to a transformed life.
Originally posted on Changethroughtransformation's Weblog:
Thank you for being a part of my journey today. I continue sharing my process from 2010. Thank you for your comments. I appreciate you. This is not easy for me to do and yet necessary for me to share the truth of my healing journey. I haven’t read these since writing. I am very grateful for my healing. I hope by sharing this it will help others as it helps me. Though my prison was created by the choices of my parents, I’ve set myself free by my choices that has moved me from victim to victor.
A few days have gone by since I’ve connected. I needed some time and space to rest and to eat before we move on. There have been different emotions today. I don’t know how to separate it all out. I took a nap this afternoon and had a dream about mother. …
View original 4,665 more words
I am becoming more firmly convinced that the health care system is so screwed up that recovery is challenging at best. Wonder if we should call in palliative care for our health care system?
THE GREAT INSURANCE RUN-AROUND!
Yesterday was a red-letter day when it comes to getting the run-around from all sources. Even the great Mayo Clinic contributed (but we’ll get to that later). Since this is in two parts – the first part was posted yesterday and can be seen here: http://chuckgallagher.wordpress.com/2013/11/26/health-insurance-companies-and-the-ethics-of-health-care-you-aint-gonna-believe-this/
In my case since I was denied the test that I need to identify the source of my recurrent prostate cancer, I elected to call Blue Cross – Blue Shield of SC. Ooops…calling – well that’s not possible. Rather you have to communicate through their BC/BS website (something I can do, but not sure it’s easy for all customers/patients). The connection with BC/BS was to appeal their denial.
BC/BS says – Sorry, but National Imaging Association is who issued the pre-approval denial and they would have to be the ones to reconsider. Fair enough…
So I call National Imaging Association and was told that I was denied because the Mayo Clinic in its submission for approval indicated “Prostate Cancer” but did not provide a “tissue diagnosis”? Bureaucratic bulls**t. What tissue is there to diagnose? My PSA is rising and that has only one practical source – recurrent prostate cancer.
CHINK IN THE MAYO CLINIC ARMOUR
Following the logical process…I follow up with the Mayo Clinic pre-certification folks and am told that they have done all they can do and that a peer-to-peer might be in order. Seems reasonable to me. So I am told to talk to Dr. Kwon’s admin to seek his help.
Moments later I talk to Dr. Kwon’s admin and, well I must have called either on a bad day or too late in the day.
“Why are you calling me?”
“The folks at the Mayo pre-authorization or certification dept told me to call as a peer-to-peer might be in order,” was my response. They just told me this minutes ago.
“They shouldn’t be doing this. Dr. Kwon is not going to do a peer-to-peer with an insurance company. Do you mind if I put you on hold while I resolve this with the pre-authorization dept. They should have never had you call me.”
On hold…and I’m thinking “well that didn’t go well” – as the patient what message was sent that my doctor who is the champion of this particular procedure would not do a peer-to-peer. I really do get it…that is time and time is money, but reality is if that is what is required surely there is a solution other than complaining about receiving a re-referral from another department within the Mayo organization.
I’m becoming more and more confident that the insurance company game is played this way: DENY! – wait and see if the patient or doctor’s office gives up = INSURANCE COMPANY WINS!
Well, I don’t give up that easily either with the insurance company or the Mayo Clinic.
Looks like its back to the phones for me!
YOUR COMMENTS ARE WELCOME!