Re: YOU are your only true advocate
From: anonymous (anonymous@obgyn.net)
Wed Dec 31 18:15:18 2008
Kristy,
Not trying to be ugly here, but what type of endo is NOT considered the
kind that recurs?
At Sun, 21 Dec 2008, Kristy wrote:
>
>I hope that you win your appeal. However, someone like me with PPO
>insurance I would still have to pay my portion even with an expert in my
>area (and the one that is in my area that is considered an expert I
>would not go back to nor would he take me back, besides he stated in my
>records-but didn't tell me this-that my endo is the kind that recurs).
>
>If you are interested in knowing who I saw e-mail me off list and I will
>tell you who I saw 11 years ago.
>
>At Sat, 20 Dec 2008, anonymous wrote:
>>
>>I have PPO insurance and am currently appealing my insurance to pay all
>>of the cost of my surgery. It should be mentioned, anyone who is
>>interested in seeing an actual expert always has the option of appealing
>>to your insurance company to pay for the surgery at in network costs
>>before you have the surgery, before you set up a date, etc. Research,
>>try to find a local gyn that would recommend seeing an actual expert. It
>>is a hard, time consuming thing, dealing with insurance companies to
>>this extent, but it has worked for some women and may work for
>>others-never know unless you try!
>>
>>At Fri, 19 Dec 2008, Kristy wrote:
>>>
>>>Even with insurance (depending on the kind of insurance one has) it can
>>>still be too cost prohibitive even with finding another doctor like some
>>>of the others that have been named on this board.
>>>
>>>Some of us have a PPO where we have to pay about 10-20% of the left over
>>>after the insurance pays their part.
>>>
>>>And if the plan is set up a certain way when it comes to insurance you
>>>have to pay a co-pay for the pre-op visit.
>>>
>>>At Fri, 19 Dec 2008, NWeber wrote:
>>>>
>>>>Kristy,
>>>>I completely understand what you mean and I was in the same position.
>>>>However, just because you can't afford to go to the CEC or Dr. Redwine
>>>>doesn't mean you cannot have excision surgery. I had excision surgery
>>>>and it was fully covered by my insurance. You just have to do some
>>>>digging :)
>>>>
>>>>If you would like the name of my doctor who did mine let me know. He is
>>>>out of Dallas TX and he is wonderful.
>>>>
>>>>All of you out there know, there are other options besides the CEC for
>>>>excision. I would have loved to go to the CEC, but I could not afford
>>>>the out of pocket costs. I sent my records to them and got their
>>>>treatment plan, and then I took them to my excision doctor that was
>>>>closer and covered fully.
>>>>
>>>>you can email me at davidandnicole@sunflower.com if you like.
>>>>
>>>>At Fri, 19 Dec 2008, Kristy wrote:
>>>>>
>>>>>It is so true that we are our own advocate, and that our health should
>>>>>be more important than the material things we value in the world.
>>>>>
>>>>>But sometimes, even with making health a priority there are things about
>>>>>the treatment for health issues that can't be afforded and may never be
>>>>>affordable for many. And unfortunately for someone like me excision
>>>>>with a top specialist will never be an option due to the cost.
>>>>>
>>>>>While it is true that excision surgery with a top specialist works for a
>>>>>lot of women so that they can get on with their lives-for which I am
>>>>>happy for them-I have also met a few women over the years who had
>>>>>surgery done with top experts and the excision surgery did not work for
>>>>>them and they continued to have problems with their endo.
>>>>>
>>>>>Being our own advocate is very important and researching all our options
>>>>>to see what works best for us.
>>>>>
>>>>>At Fri, 19 Dec 2008, ampyali wrote:
>>>>>>
>>>>>>I want to say that first of all, I have been an RN for 21 years, most of
>>>>>>that time spent working in the ICU. I have worked with doctors from all
>>>>>>specialties and backgrounds. Before I was diagnosed with endo, I
>>>>>>understood that skill and knowledge level of doctors varied greatly, but
>>>>>>I still believed that they all, for the most part, had their patient's
>>>>>>best interests at heart. I had no clue when it came to insurance
>>>>>>reimbursement and the overwhelming effect it has on the care someone
>>>>>>receives. Since my endo diagnosis 1 1/2 years ago i discovered the
>>>>>>awful truth, and that is that unless you are paying for your medical
>>>>>>care out of pocket, your insurance company has the greatest say in the
>>>>>>care that you receive. The only remedy to this is to be fully aware of
>>>>>>your options, to educate yourself completely about your disease process,
>>>>>>to read, from beginning to end, how your insurance pays for your care,
>>>>>>and to question EVERYTHING.
>>>>>>
>>>>>>Because of the experience I've had over the last 1 1/2 years I learned
>>>>>>that ob/gyns get reimbursed mostly for delivering babies, not helping
>>>>>>women with endo. Excision surgery is not covered by insurance because
>>>>>>it takes way too long to perform. You average gyn surgeon is reimbursed
>>>>>>for less than an hour of his or her time during a typical laparoscopy.
>>>>>>They have time to get in, burn and laser whatever they can see (which is
>>>>>>easily visible and typical-looking endo), and get out. My endo
>>>>>>specialist, who finally relieved my pain and suffering through excision
>>>>>>surgery, holds the record for the longest time in the OR at the hospital
>>>>>>where he performs his surgeries: 11 hours. No insurance company is
>>>>>>going to reimburse him for this quantity of time, yet this is what it
>>>>>>sometimes takes to do the job properly.
>>>>>>
>>>>>>Lupron is so popular because it doesn't involve surgery, it is quick and
>>>>>>easy to administer, and the doctors are reimbursed for each dose at a
>>>>>>very high rate. It doesn't even require a specialist to prescribe--your
>>>>>>basic primary care provider is authorized to diagnose and treat even
>>>>>>suspected endo with it. Most of the common side-effects of Lupron are
>>>>>>controlled with inexpensive "add-back" therapy. The problem with Lupron
>>>>>>is that it doesn't actually treat the disease, it only masks the problem
>>>>>>for the time period in which it is used. The endo sufferer is left with
>>>>>>her disease intact and potential long-term side effects from the drug.
>>>>>>
>>>>>>Excision surgery with an endo specialist can be expensive--I don't deny
>>>>>>that. But I think we all have to realize that our health is so much
>>>>>>more important than many other material things we think we value in this
>>>>>>world. I know how useless I was to my family while I was suffering from
>>>>>>the pain, headaches and bowel symptoms from my endo. I was exhausted
>>>>>>and grumpy most of the time. My children didn't deserve to have so much
>>>>>>attention focused on mommy all the time, and my husband didn't need to
>>>>>>work all day and then have to make up for what I couldn't get done when
>>>>>>he got home.
>>>>>>
>>>>>>I realized because of this experience that I am much more alone than I
>>>>>>thought I was. I had the laparoscopy and "treatment" of my endo with a
>>>>>>typical gyn surgeon. My pain returned 3 weeks later, much worse that it
>>>>>>was before. I am so grateful that I discovered the truth about endo
>>>>>>soon after that and was able to get REAL and lasting treatment for my
>>>>>>endo. I know there is no guarantee that it won't come back, but the
>>>>>>specialist felt that the chances for it doing so were very, very small.
>>>>>>I've returned to normal life, normal energy level, no headaches, and my
>>>>>>GI tract is working amazingly well for the first time in 20 years.
>>>>>>
>>>>>>Best wishes and blessings to you all as you look for answers and a
>>>>>>return to healthy, pain-free lives.
>>>>>
>>>>>--
>>>>>=====
>>>>>Kristy :)
>>>>>
>>>>>http://www.geocities.com/sokokl/Kristysstory.html
>>>>>
>>>--
>>>=====
>>>Kristy :)
>>>
>>>http://www.geocities.com/sokokl/Kristysstory.html
>>>
>--
>=====
>Kristy :)
>
>http://www.geocities.com/sokokl/Kristysstory.html
>
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