Guest guest Posted November 20, 2008 Report Share Posted November 20, 2008 OH angela!!! Honey I'm so sorry you are dealing with these butt head doctors!!! Have you talked to Dr. Rice's office about this? They may have patient advocates there at CCF that could help you!! TONIA!!!!!!!!!!!!!!!!!!!!!!!! I know she had one!!! I'm sure she will chime in here!!!!! First you need to calm down, I know that it isn't easy dealing with all of this!! But you don't want to upset Dakota either!!! Little ones seeing their parents upset makes them upset, which doesn't help the situation!!! We are all here for you.. I'm SURE some one will help you!!! Hang in there Honey it will be ok!!!! If you need someone to talk to I'm always home.well almost always!!! You can call if you just need to vent!! 479-986-8838!! From: achalasia [mailto:achalasia ] On Behalf Of kotacj Sent: Thursday, November 20, 2008 3:32 PM achalasia Subject: hmo nightmare dakota's gi doc is refusing to write us a letter of medical necessity which will help us in our quest to have dr rice operate. dr barrette barnes of vua want us to let dr bradely rodgers operate on dakota. he says because he works with dr rodgers he is obligated to refer to my son to dr rodgers because he, dr barnes, " depends on his relationship " with the doctors at uva. since when does a doctor not consider what the patient wants. i am cring so hard right now i can't even see how type. please please help me. should i get a lawyer? i only wants dr rice, i don't doubt dr rodgers is a good surgeon but he has only done 7 of these procedures and one of the seven had to go back. he has not kept tract of his previous patients and refuses to give us any phones numbers or information regarding his patient outcomes. when asked about the fact dakota has eosinophilic esophagitis and the impact it could have on surgery he, dr rodgers said " he didn't know. " when ask how dakota gastropresis will impact the surgery he said " i don't " know. what the hell... please if anyone can advise me, please...angela Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 20, 2008 Report Share Posted November 20, 2008 wrote: > dakota's gi doc is refusing to write us a letter of medical necessity ... For me it was my primary doctor that did the letter not the GI. I called his office and told them I was ready to see a surgeon and that I had found one at Mayo and could they set it up. They did. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 20, 2008 Report Share Posted November 20, 2008 Here are a few articles that mention the learning curve in Heller myotomies. The first three might be useful to print out, highlight the relevant portions and show to the GI and/or HMO, especially the first article below. (The last would not. I was surprised to read its conclusion.) http://www.ncbi.nlm.nih.gov/pubmed/12002295 " After approximately 20 videoscopic Heller myotomies, surgeons can expect fewer conversions to open procedures, shorter hospital stays, and better symptomatic relief. " http://ats.ctsnetjournals.org/cgi/reprint/80/4/1191.pdf " As experience is gained, the incidence of intraoperative complications has decreased significantly (p = 0.0075). " www.ncbi.nlm.nih.gov/pubmed/10921184 " The higher incidence of mucosal tears during the first 30 operations suggests the effect of the learning curve. " An opposing view: http://www.ncbi.nlm.nih.gov/pubmed/18488266 (The first 10-20 laparoscopic myotomies had a longer operating time and were more often converted to open procedures, but:) " Intraoperative complications, overall satisfaction with the outcome, reoperation rate, and postoperative dysphagia were *not* associated with the institutional or the surgeon's operative experience. " in PA hmo nightmare > dakota's gi doc is refusing to write us a letter of medical necessity > which will help us in our quest to have dr rice operate. dr barrette > barnes of vua want us to let dr bradely rodgers operate on dakota. he > says because he works with dr rodgers he is obligated to refer to my > son to dr rodgers because he, dr barnes, " depends on his > relationship " > with the doctors at uva. since when does a doctor not consider what > the > patient wants. i am cring so hard right now i can't even see how type. > please please help me. should i get a lawyer? i only wants dr rice, i > don't doubt dr rodgers is a good surgeon but he has only done 7 of > these procedures and one of the seven had to go back. he has not kept > tract of his previous patients and refuses to give us any phones > numbers or information regarding his patient outcomes. when asked > about > the fact dakota has eosinophilic esophagitis and the impact it could > have on surgery he, dr rodgers said " he didn't know. " when ask how > dakota gastropresis will impact the surgery he said " i don't " know. > what the hell... please if anyone can advise me, please...angela > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 20, 2008 Report Share Posted November 20, 2008 I have a friend that used to work for Pacificare, but not one of the people you would talk to on the phone, but she was in management in the administration of the clients, working w/ HR departments. She told me that threats from the clients that they were going or did go to the state insurance commissioner got them to move up the ladder and reach a satisfactory resolution quickly. Same with a lawyer, but I'd suggest the insurance commissioner. She said that was about the only way to get speed out of them, then your problem went to a diffent group of people specializing in avoiding litigation, meaning you get the doctors you want. As always, (but I don't do it always) it is a good idea to keep a journal of dates, times, names and phone numbers and what was said when you fight your HMO. One easy way is to just send an email confirming a phone conversation or whatever. If I'm really organized I set up a folder in my email boxes for each client (for instance) and move that email there. Also, if I just want to document something, attach a file, or whatever, I send it to myself and file it in that box when it reappears as inmail. It is a great way to keep track w/o paper and if EVER proof is needed in court or mostly the threat of court, there it is, all date stamped. If you can scan tests and keep them there also. There are other programs, more complicated, but I've found the email technique very handy, and easier than the messy paper files. You organized ones are rolling your eyes, as this comes naturally to you. Be assertive, perhaps threaten, ask advice from the goof you might be talking to on the phone how to move up the chain of command, they may just be doing their job and secretly are on your side and will help you. Keep asking for the next supervisors and copy quote any stupid comments, such as the doctor saying he wants to stay friends w/ his peers. They probably already don't respect him... that would be grounds for malpractice I'd think if that quote appeared in court. My same Pacificare friend said she often saw the staff crying at lunch or at breaks if they had a rough day and had to keep turning people down. It was so stressful that ambulances often came when these workers snapped mentally or physically. For some HMO's there is incredible pressure to keep you in their network and keep costs low. You will find a way. There may be some angels that will help you when you least expect it. Sandy > > dakota's gi doc is refusing to write us a letter of medical necessity > which will help us in our quest to have dr rice operate. dr barrette > barnes of vua want us to let dr bradely rodgers operate on dakota. he > says because he works with dr rodgers he is obligated to refer to my > son to dr rodgers because he, dr barnes, " depends on his relationship " > with the doctors at uva. since when does a doctor not consider what the > patient wants. i am cring so hard right now i can't even see how type. > please please help me. should i get a lawyer? i only wants dr rice, i > don't doubt dr rodgers is a good surgeon but he has only done 7 of > these procedures and one of the seven had to go back. he has not kept > tract of his previous patients and refuses to give us any phones > numbers or information regarding his patient outcomes. when asked about > the fact dakota has eosinophilic esophagitis and the impact it could > have on surgery he, dr rodgers said " he didn't know. " when ask how > dakota gastropresis will impact the surgery he said " i don't " know. > what the hell... please if anyone can advise me, please...angela > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2008 Report Share Posted November 21, 2008 Please, please get another GI doc who could write you a letter to Dr. Rice. Maybe someone in this group could give you the name of a better and more experienced GI doc. who has experience with Achalasia and could referre you. My God there are some ignorant doctors who think only of themselves and their own financial gains never mind the patient and their needs. I went through something of this kind of nightmare myself before I was referred by another doctor to see a surgeon. My first GI doctor couldn't care less about my feelings as regards surgical treatment and was determined to keep me on medication to control my Achalasia symptoms despite my going down on bended knees to him for a referral to a surgeon. He would much rather I remained in pain for the rest of my life. In the end I saught help through a Patient Association here in the UK and they helped me with advice on who to see here in the UK for help. Good Luck to you. Please keep this group informed on how things go for you. ________________________________ From: kotacj <kotacj@...> achalasia Sent: Thursday, November 20, 2008 9:31:49 PM Subject: hmo nightmare dakota's gi doc is refusing to write us a letter of medical necessity which will help us in our quest to have dr rice operate. dr barrette barnes of vua want us to let dr bradely rodgers operate on dakota. he says because he works with dr rodgers he is obligated to refer to my son to dr rodgers because he, dr barnes, " depends on his relationship " with the doctors at uva. since when does a doctor not consider what the patient wants. i am cring so hard right now i can't even see how type. please please help me. should i get a lawyer? i only wants dr rice, i don't doubt dr rodgers is a good surgeon but he has only done 7 of these procedures and one of the seven had to go back. he has not kept tract of his previous patients and refuses to give us any phones numbers or information regarding his patient outcomes. when asked about the fact dakota has eosinophilic esophagitis and the impact it could have on surgery he, dr rodgers said " he didn't know. " when ask how dakota gastropresis will impact the surgery he said " i don't " know. what the hell... please if anyone can advise me, please...angela Quote Link to comment Share on other sites More sharing options...
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