NOYFB
Ideal_Rock
- Joined
- Nov 16, 2008
- Messages
- 2,649
Hi everyone,
I'm asking for some PS dust, prayers, positive thoughts, whatever you can spare, etc, as I'm facing a potential health crisis. I had my yearly mammogram last week and got a call back the next day that I needed a "spot compression" for a suspicious area on my left breast. I went in for that on Tuesday, and, after waiting for about 30 minutes, with my little white robe on in the waiting room, was told that they wanted to do an ultrasound, too. I was not expecting that, but got it done and was told by the tech "Ok, you should be hearing from your doctor by Friday.". Of course, I was concerned, because I'm thinking "Why can't they just tell me now what's going on?". I go to a specialized Breast Center in a hospital. My sister, who is 4.5 years older than me had the same scenario a few months ago and they came right in afterward and told her everything was fine and to come back next year. So, being told that my doctor will call me with the results had me anxious, obviously.
Well, that evening, my doctor called me and told me that there is a mass that needs to be biopsied and gave me the name and number of a surgeon. At this point, I am freaking out. A little bit of history - my mother was diagnosed with breast cancer 10 years ago, which is when I started going for annual mammograms. My aunt (mom's sister) also had breast cancer, although I'm not sure exactly when. I've had one other spot compression a few years ago, but whatever showed up on the mammo disappeared in the spot compression. This mass did not, hence the need for ultrasound.
I'm terrified and not quite sure what to expect. I do know that regardless if the mass if benign or malignant, I will be having it removed, and I am trying to prepare myself for that. Again, dust, prayers, positive energy, etc, all appreciated.
Now for the rant...I have an HMO. Although I work in healthcare, my company's health insurance is awful, so I am on DH's United Healthcare HMO. I haven't had an HMO in years, and I'm starting to realize why. We both have the same PCP, who we've been seeing for a few years. We love him and he's great. I've also been seeing my gyne for over 10 years and I trust her (she did my hysterectomy 5 years ago). They are not, however, within the same hospital system. Because I have an HMO, any referral to a specialist (i.e. the surgeon) requires a referral from my PCP. So, I called my PCP's office yesterday and spoke with Pamela, the office secretary. It's a very small practice and I used to work in the same hospital, so I've known and communicated with Pamela for some time. She's usually pleasant enough and seemed competent. Until yesterday.
When I explained to her the situation and that I needed I referral she literally sighed out loud and said she a) didn't think I really had an HMO, b) didn't have a referral form and c) didn't do that sort of thing. I calmly explained that yes, I do have an HMO and that after talking to my insurance company I confirmed that a referral needed to be done on the United Healthcare website, so all she needed to do was go online and fill in a few pieces of information. I gave her all of my doctor's information (even though it was on all of the reports that I had them fax to her), and the surgeon's information (even though I had given it to her the day before). Again, I received heavy sighs and was told that she didn't have time for this, that she had spent over an hour on the phone with my insurance company and got transferred to 6 different people, etc...on and on and on...and finally told me "as soon as this is taken care of, we are dropping out of the network, sorry", very unapologetically. I made several calls to her and to my insurance company and they actually ended up calling her and talking to her while I waited on hold. At this point, she told me that she had spoken to my PCP and he thought it was something that could just be "monitored'. I advised her to please read the US report that specifically stated that a biopsy was necessary. I realized then that she hadn't even read the reports because she was like "Oh, I see that...let me highlight that for the doctor". Then she came back and told me that my PCP didn't think I needed to see a surgeon for the biopsy, and that I could just go to Interventional Radiology at the hospital where he works. I explained to her that I have been going to the Breast Center for years and that the biopsy will be an ultrasound guided biopsy done at the Breast Center and that my gyne recommended this particular surgeon for a reason. Again, more heavy sighs and "I'll have to talk to him, but since we're planning to drop United Healthcare you may want to find a new PCP at the same hospital where your gyne is". It was all very rude and not patient-centered care at all. I had to struggle to be calm and nice because I really need her to do this for me.
Side note - I did try to get a new PCP but any changes that I make will not take effect until 8/1/14 and my surgical consultation is scheduled for 7/7. I don't have time to wait.
So, basically, she's telling me that I'm inconveniencing her and that I need to get a new doctor because she doesn't have time to deal with me. She even admitted to not being computer savvy and having to sit down with her husband to go through the online referral process (hello, HIPAA!!!!).
I'm so upset with her and the whole healthcare system as a whole. I mean, I'm sorry that the fact that I may have breast cancer is such an inconvenience to you! I'm sorry that you're computer illiterate and can't deal with an online referral process! It's 2014, for crying out loud. Welcome to the world of managed care and social media. If you're going to drop contracts with any insurance company that only deals with online referrals you better get ready to go out of business. Seriously, what the hell????
In the end, nothing got resolved and she said I'd need to come in on Monday to see my PCP before a referral can even be done. I'm sure she's secretly thinking he'll talk me out of it so she doesn't have to be bothered with me. That's not happening. I've got enough reasons why a) I need this consultation/surgery and b) why I need to use this particular surgeon.
I've you've read this whole thing, thank you. I needed to get that off my chest (literally and figuratively).
I'm asking for some PS dust, prayers, positive thoughts, whatever you can spare, etc, as I'm facing a potential health crisis. I had my yearly mammogram last week and got a call back the next day that I needed a "spot compression" for a suspicious area on my left breast. I went in for that on Tuesday, and, after waiting for about 30 minutes, with my little white robe on in the waiting room, was told that they wanted to do an ultrasound, too. I was not expecting that, but got it done and was told by the tech "Ok, you should be hearing from your doctor by Friday.". Of course, I was concerned, because I'm thinking "Why can't they just tell me now what's going on?". I go to a specialized Breast Center in a hospital. My sister, who is 4.5 years older than me had the same scenario a few months ago and they came right in afterward and told her everything was fine and to come back next year. So, being told that my doctor will call me with the results had me anxious, obviously.
Well, that evening, my doctor called me and told me that there is a mass that needs to be biopsied and gave me the name and number of a surgeon. At this point, I am freaking out. A little bit of history - my mother was diagnosed with breast cancer 10 years ago, which is when I started going for annual mammograms. My aunt (mom's sister) also had breast cancer, although I'm not sure exactly when. I've had one other spot compression a few years ago, but whatever showed up on the mammo disappeared in the spot compression. This mass did not, hence the need for ultrasound.
I'm terrified and not quite sure what to expect. I do know that regardless if the mass if benign or malignant, I will be having it removed, and I am trying to prepare myself for that. Again, dust, prayers, positive energy, etc, all appreciated.
Now for the rant...I have an HMO. Although I work in healthcare, my company's health insurance is awful, so I am on DH's United Healthcare HMO. I haven't had an HMO in years, and I'm starting to realize why. We both have the same PCP, who we've been seeing for a few years. We love him and he's great. I've also been seeing my gyne for over 10 years and I trust her (she did my hysterectomy 5 years ago). They are not, however, within the same hospital system. Because I have an HMO, any referral to a specialist (i.e. the surgeon) requires a referral from my PCP. So, I called my PCP's office yesterday and spoke with Pamela, the office secretary. It's a very small practice and I used to work in the same hospital, so I've known and communicated with Pamela for some time. She's usually pleasant enough and seemed competent. Until yesterday.
When I explained to her the situation and that I needed I referral she literally sighed out loud and said she a) didn't think I really had an HMO, b) didn't have a referral form and c) didn't do that sort of thing. I calmly explained that yes, I do have an HMO and that after talking to my insurance company I confirmed that a referral needed to be done on the United Healthcare website, so all she needed to do was go online and fill in a few pieces of information. I gave her all of my doctor's information (even though it was on all of the reports that I had them fax to her), and the surgeon's information (even though I had given it to her the day before). Again, I received heavy sighs and was told that she didn't have time for this, that she had spent over an hour on the phone with my insurance company and got transferred to 6 different people, etc...on and on and on...and finally told me "as soon as this is taken care of, we are dropping out of the network, sorry", very unapologetically. I made several calls to her and to my insurance company and they actually ended up calling her and talking to her while I waited on hold. At this point, she told me that she had spoken to my PCP and he thought it was something that could just be "monitored'. I advised her to please read the US report that specifically stated that a biopsy was necessary. I realized then that she hadn't even read the reports because she was like "Oh, I see that...let me highlight that for the doctor". Then she came back and told me that my PCP didn't think I needed to see a surgeon for the biopsy, and that I could just go to Interventional Radiology at the hospital where he works. I explained to her that I have been going to the Breast Center for years and that the biopsy will be an ultrasound guided biopsy done at the Breast Center and that my gyne recommended this particular surgeon for a reason. Again, more heavy sighs and "I'll have to talk to him, but since we're planning to drop United Healthcare you may want to find a new PCP at the same hospital where your gyne is". It was all very rude and not patient-centered care at all. I had to struggle to be calm and nice because I really need her to do this for me.
Side note - I did try to get a new PCP but any changes that I make will not take effect until 8/1/14 and my surgical consultation is scheduled for 7/7. I don't have time to wait.
So, basically, she's telling me that I'm inconveniencing her and that I need to get a new doctor because she doesn't have time to deal with me. She even admitted to not being computer savvy and having to sit down with her husband to go through the online referral process (hello, HIPAA!!!!).
I'm so upset with her and the whole healthcare system as a whole. I mean, I'm sorry that the fact that I may have breast cancer is such an inconvenience to you! I'm sorry that you're computer illiterate and can't deal with an online referral process! It's 2014, for crying out loud. Welcome to the world of managed care and social media. If you're going to drop contracts with any insurance company that only deals with online referrals you better get ready to go out of business. Seriously, what the hell????
In the end, nothing got resolved and she said I'd need to come in on Monday to see my PCP before a referral can even be done. I'm sure she's secretly thinking he'll talk me out of it so she doesn't have to be bothered with me. That's not happening. I've got enough reasons why a) I need this consultation/surgery and b) why I need to use this particular surgeon.
I've you've read this whole thing, thank you. I needed to get that off my chest (literally and figuratively).
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