Things Improving After Breaking Free from a Medicare Advantage HMO
Susan_E
Member Posts: 9
Because so many people diagnosed with EC are over the age of 65, I wanted to share my personal experiences dealing with my dad's health insurance company. My dad had a Medicare Advantage HMO policy through a small, regional insurance company.
My dad was diagnosed with EC in November 2010. He had complained of symptoms earlier. However, he had to receive a referral to a specialist, wait for an approval from his insurance company to see the specialist, and then was forced to wait for yet another approval to undergo the tests the specialist ordered. Needless to say, things moved at a snail's pace.
The insurance company's directory of providers was very limited when it came to oncologists. There were no major hospitals or cancer treatment facilities listed. The oncologist my dad was sent to was a DO, not an MD, and wasn't board certified. I'm not sure what his exact words to my dad were. However, my dad received the impression that he should go home and die because there was nothing that could be done. If that wasn't bad enough, he gave my dad 3-6 months to live.
While we were fighting with the insurance company to approve a second opinion at UCLA, USC, or Cedars Sinai, they sent a representative to my parents home to discuss end-of-life care. They were mistakenly under the impression my dad wasn't able to leave the house and needed hospice care. Each request we made for a second opinion was denied. When we appealed their decision, they refused to grant the appeal rush status because they did not feel it was an urgent issue.
Each step of the way, at every turn, pennies were pinched and my dad was denied the care and attention he desperately needed.
After I learned my dad could change insurance companies during Medicare's open enrollment, despite the fact that he had a pre-existing condition, I worked with an insurance agent to find the right policy. I knew switching policies would result in some critical time being lost. However, I felt this was a price we'd have to pay. Now that my dad has been on his new insurance for 16 days, it's a change that may have saved his life.
The old insurance policy required my dad to go to specific hospitals (small, community hospitals) where they had their own doctors with the insurance company's logo on their white coats. Even while in the hospital, I have no doubt that the insurance company limited procedures, treatment, and diagnostic tests. While he was in the hospital for 4-5 days last December, nobody even took the time to get him out of bed and walk him down the hall.
With my dad's new insurance, a PPO through a major insurance company, his oncologist was able to have him admitted to Cedars Sinai in Los Angeles after his condition significantly declined last week. He now has two excellent doctors on his case, an internist and a gastroenterologist, who are able to order diagnostic tests without obtaining insurance authorization. This proved to be vital when they did an ultrasound of my dad's legs and discovered a blood clot. They were able to put him on a blood thinner right away which may have ultimately saved his life.
Cedars Sinai has been a blessing to my family. My dad is making progress and receiving top-notch care. None of this would have been possible had my dad stayed with his old health insurance company.
None of us expect to get sick, so we don't really pay attention to these things while we still have our health. Please take the time to look at your insurance company's directory of healthcare providers to see what your options are in the event you're diagnosed with cancer - especially if you're with an HMO.
My dad was diagnosed with EC in November 2010. He had complained of symptoms earlier. However, he had to receive a referral to a specialist, wait for an approval from his insurance company to see the specialist, and then was forced to wait for yet another approval to undergo the tests the specialist ordered. Needless to say, things moved at a snail's pace.
The insurance company's directory of providers was very limited when it came to oncologists. There were no major hospitals or cancer treatment facilities listed. The oncologist my dad was sent to was a DO, not an MD, and wasn't board certified. I'm not sure what his exact words to my dad were. However, my dad received the impression that he should go home and die because there was nothing that could be done. If that wasn't bad enough, he gave my dad 3-6 months to live.
While we were fighting with the insurance company to approve a second opinion at UCLA, USC, or Cedars Sinai, they sent a representative to my parents home to discuss end-of-life care. They were mistakenly under the impression my dad wasn't able to leave the house and needed hospice care. Each request we made for a second opinion was denied. When we appealed their decision, they refused to grant the appeal rush status because they did not feel it was an urgent issue.
Each step of the way, at every turn, pennies were pinched and my dad was denied the care and attention he desperately needed.
After I learned my dad could change insurance companies during Medicare's open enrollment, despite the fact that he had a pre-existing condition, I worked with an insurance agent to find the right policy. I knew switching policies would result in some critical time being lost. However, I felt this was a price we'd have to pay. Now that my dad has been on his new insurance for 16 days, it's a change that may have saved his life.
The old insurance policy required my dad to go to specific hospitals (small, community hospitals) where they had their own doctors with the insurance company's logo on their white coats. Even while in the hospital, I have no doubt that the insurance company limited procedures, treatment, and diagnostic tests. While he was in the hospital for 4-5 days last December, nobody even took the time to get him out of bed and walk him down the hall.
With my dad's new insurance, a PPO through a major insurance company, his oncologist was able to have him admitted to Cedars Sinai in Los Angeles after his condition significantly declined last week. He now has two excellent doctors on his case, an internist and a gastroenterologist, who are able to order diagnostic tests without obtaining insurance authorization. This proved to be vital when they did an ultrasound of my dad's legs and discovered a blood clot. They were able to put him on a blood thinner right away which may have ultimately saved his life.
Cedars Sinai has been a blessing to my family. My dad is making progress and receiving top-notch care. None of this would have been possible had my dad stayed with his old health insurance company.
None of us expect to get sick, so we don't really pay attention to these things while we still have our health. Please take the time to look at your insurance company's directory of healthcare providers to see what your options are in the event you're diagnosed with cancer - especially if you're with an HMO.
0
Comments
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Thank You!
Dear Susan
Thank you for your useful information! I am so happy to read that your dad is now doing so much better, and being much better taken care of! Wow! Thank God for you and your determination. Health Insurance Co.'s at most times can be very confusing. I know this will be helpful to others on this board. Best wishes to your dad and your family as you continue to fight and win this battle with ec. My dad was dx in 11/08 fought for 16 mos. and passed away March 9,2010, after his ec went to his liver. EC is definitely a beast, but it can be beat. Keep up the fight!
Tina in Va0 -
I SO AGREE
Susan,
Working in the medical field myself I understand your frustration, and know you had a road to walk, and got lucky. I do have an HMO but its owned by the hospital I work for so I know how to do the red tape. I am so glad you just kept the fight and found the right one, I know you did well and now he will have a wonderful journey to complete.
If i can help in anyway please let me know
Thanks
Lori/aka moe580 -
This comment has been removed by the ModeratorMOE58 said:I SO AGREE
Susan,
Working in the medical field myself I understand your frustration, and know you had a road to walk, and got lucky. I do have an HMO but its owned by the hospital I work for so I know how to do the red tape. I am so glad you just kept the fight and found the right one, I know you did well and now he will have a wonderful journey to complete.
If i can help in anyway please let me know
Thanks
Lori/aka moe580
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