2013 in review – Blog Stats from WordPress – Thanks to all my readers!

December 30, 2013

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.

Click here to see the complete report.


Eviscerating The Sound Of Music Live

December 8, 2013

Eviscerating The Sound Of Music Live.

via Eviscerating The Sound Of Music Live.


When Prostate Cancer Returns – Between a Rock and a Hard Place with Health Insurance – Part 10

December 2, 2013

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!!!

My last entry is here: https://chuckgallagher.wordpress.com/2013/11/27/when-prostate-cancer-returns-ouch-mayo-clinic-fumbles-the-ball-part-9/

NEWS on the MAYO FRONT!

Mayo Clinic LogoToday I get an inpatient email from the Mayo Clinic  that stated the following:

Your PSA is still 1.1–which is a good thing that it’s not moving anywhere quickly. Per Dr. Kwon I have placed orders for a prostate MRI and a return with Dr. Kwon. If you get the C11 PET approved through your insurance, please let me know and I will also order that scan for you.

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!

Dr. Kwon will do a peer to peer review. Just call our pre-certification office to set it up at XXX-XXX-XXXX.

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!


When Prostate Cancer Returns – Ouch Mayo Clinic Fumbles the ball… Part 9

November 27, 2013

Some posts are simple and don’t require many words.

Mayo Clinic LogoMayo Clinic pre-certification department – 100% satisfaction rating.  Talking about a group that has gone above and beyond the call of duty…these folks certain have.  Hats off to you.

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!


Healing from Sexual Abuse – A Transformational Journey – Part 4

November 27, 2013

chuckgallagher:

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.

Entry 4:

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


When Prostate Cancer Returns – The Great Health Insurance Run-around! – Part 8

November 27, 2013

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?

Blue Cross Blue Shield LogoMany of you have been following my journey dealing with recurring Prostate Cancer.  Treatable?  Yes!  Easy?  No!!!

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:  https://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

Mayo Clinic LogoFollowing 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.

THE GAME

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!


Health Insurance Companies and the Ethics of Health Care…You Ain’t Gonna Believe This!

November 26, 2013

Some may know – especially those who have been following my most recent blogs related to a return of Prostate Cancer that I’ve been dealing with – but today was a Red Letter day when it comes to Health Insurance, Health Insurance Companies and how they ethically (oops unethically) deal with their customers.  I am not sure how we got here, but where we are when it comes to our health and how that is paid for is so broken it’s quite unbelievable.

WHAT’S THE SCOOP?

healthcareToday was a follow up visit with my local doctor.  Nothing special and almost a waste of time, but the appointment was scheduled and kept.  Routine visit – weight, blood pressure, temperature, and nothing unusual.  Today I was to receive the results of my bone scan and CT scan, but since I got a CD with the data ready to send to the Mayo Clinic (which of course I read – not that I’m a doctor, but I can read, and a report that says nothing was found was exactly what I was expecting), which I sent, I knew the outcome before the visit.

Doctor enters the room with a pleasant smile asking me how I am.  Now that was a loaded question since I am full of frustration over the way Health Insurance companies deal with their customers (namely me).  Of course since I am the one that wants treatment, I personalize their actions.  Yes, I know better, but to me it is personal since it is my health.  So…I proceed to vent to the doctor.

“Doc, I don’t know how you deal with these insurance companies day in and day out!  They are a pain in the ass.”

“You don’t know the half of it,” he responded, “and it’s only getting worse!”

For a few minutes he openly allowed me to vent, then looked at me, removing his glasses and said, “Let me vent a bit.”

AMAZING STORY!

Of course with no identifying information shared, my doctor shared with me the most amazing story I’ve heard (and I suspect that this is nothing in comparison to many many more stories like this out there).

“So I have a patient with advanced lung cancer.  He’s been a smoker most of his life, so as you can imagine his lungs are pretty damaged.  Likewise, he has cancerous lymph nodes in his chest.  So I suggested a form of radiation treatment that is more localized to his tumor so that I can spare what little lung he has left.  If I use traditional radiation the tissue damage will create substantial problems for this man who needs to salvage as much of his lung as possible.

I submitted my request to his health insurance company.  Their reply:  DENIED.  They wanted me to use the conventional treatment!

I told the person on the phone, because by now I was personally involved, that if it were their lung or even their father in a similar situation, they would want the better treatment.  The treatment that would salvage what lung he has left.

They then suggested that I resubmit the request showing the two treatments: (1) more effective treatment and (2) conventional tissue destroying treatment.  We did that.

Got the response today:  DENIED!

I was incensed and called again for a peer to peer discussion.  Not more than 30 minutes ago I was told that the conventional treatment was all that was needed, even though I know that the damage from that will substantially diminish his quality of life and could create more medical costs down the road.

Chuck, they just don’t care!”

HOW DID WE GET HERE?

How did we get to the point that a person checking off a checklist is the determining factor into the kind of health care we receive in the United States of American?  Are we really OK with care provided at the lowest common denominator?  We we can receive quality treatment but the insurance company will only pay for adequate treatment, is that OK?

SHARE YOUR STORY

You don’t have to name names, but feel free to share your story.  Maybe if enough of us get our stories told…SOMEONE WILL LISTEN.

FEEL FREE TO SHARE YOUR STORY OR YOUR COMMENTS.


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