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

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!

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

  1. A Clark says:

    I work for a urologist and we have experienced denials for imaging studies by insurance companies several times. Each time the doctor has called for a “peer-to-peer” review he has talked where their so called “peer” who should be another physician capable of understanding the medical information and who can make a medical judgement to approve the study. However, on all occasions the insurance company physician has denied the claim stating he is following national guidelines and the patient doesn’t need the study. In other words, he isn’t using medical judgement, he is following a piece of paper and as we know all patients don’t always fit the guidelines that are written. Guidelines are for the majority of patients who have a certain illness. That is probably why your doctors at Mayo won’t do peer-to-peer reviews because they don’t work. I am sorry for your experience. It is frustrating to not only fight an illness but to fight the financial burden as well.

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