Thank you!!!

[liya771]

Hi,
Wow, what a wonderful webpage.
First, I would like to thank Bob who introduce me to this great website and very nice poeple. I also would like to thank Nancy, Johnny, Sylvia, and Rob for your responses.

I agree with all of you getting a second opinion is the only solution we have. However, she has Kaiser(HMO) insurance and Kaiser doctors don't want her to go outside the net work. So far, she has seen about four Kaiser cardiologists and they all are saying the same thing. I am sure, all the doctors are wrong because she is getting very weak to the point that she use a cane to get around the house as well as outside.

My problem is that money is an issue for us. We want the insurance company to pay for the doctor visit but we can't do it unless her doctor gives us the permision. I don't know what to do.

If anybody has any idea what I should do, please let me know.

Thank you again

Liya

 

[Ross]

No, thank you for becoming a member!

I understand your situation with Kaiser. I'm on a Medicare HMO and I have to put up with the same thing on my end. There really isn't anything you can do without leaving the plan and paying to see someone else. I realize that's not really an option. It wouldn't be for me either. I can barely pay the bills I have now.

If you truly feel that the Kaiser Cards are wrong, take it upon yourself to call someone outside of the plan, discuss a payment arrangement, and take her there. I'm sorry I don't have any better information for you. I've been that route myself, so I know what your dealing with.

 

[Georgia]

Hi, Liya. Before you go outside the network, call your state insurance department; quite a few states have a provision in statute/regulation that requires HMO's to pay for a second opinion by an out-of-network physician. Tends to keep the in-house docs honest. It's worth the call; if your state has this provision the person you talk to will give you the cite and you can tell the Kaiser people they must comply.

Good luck. You and your cousin must be especially close; I hope that things go well for her.

 

[Ross]

Thanks for posting that Georgia. It crossed my mind a little later today. Unfortunately, it being red tape and all, may take too much time to get things going. If it's the only option, go for it!

 

[Nancy]

If all else fails, here's what I would do. Make a very precise list of every symptom your cousin is having. Do it in a numbered list instead of a written paragraph. Make it short and very much to the point. Something like (this is only an example)

1. Extreme shortness of breath with exertion and at rest

2. Extreme fatigue

3. Fluid retention in legs and feet with pitting edema

4. Inability to do normal everyday things

5. Has to sleep with head elevated

6. Wakes up at night breathless

Then make a list of all the medications she is on, with the dosages.

Make it as professional as you can, typed would be the best. Then make several copies and have your cousin bring them with her.

Then when she goes to the doctor, go down the list number by number, and ask what they intend to do about each symptom.

Have your cousin tell them verbally exactly how she is feeling, holding back nothing. Have her ask about getting an echocardiogram, because she feels her symptoms are worsening and want to rule out serious problems.

If they refuse, then ask why, and write down their answers. If you aren't satisfied with the response, ask to see another member of the group and do the same exact thing with this doctor.

After the appointment, then write a letter to them relating exactly what was said during the appointment and going down your list relating what is going to be done about each symptom. Make sure it looks professional, and date it and sign it. Make several copies.

I really think she will have to put them on notice that she is going to hold them responsible for her heart health. If it appears threatening, all the better. Keep the heat on, and don't let up.

This is serious stuff here, and maybe someone has to remind those doctors.

If this doesn't work, then send all the copies of what has transpired to Kaiser for their review.

 

[jeferi]

Kaiser

Kaiser

Hi,

I am currently going through the process of getting test and procedure results from Kaiser, it has been a lot of red tape to deal with. Getting copies of the TEE and angiogram have been a real struggle. "like pulling teeth from a hungry lioness protecting her cubs". I'm getting closer. they have said I need surgery, I just wanted to consult with some "outside surgeons" to get their opinion on valve repair and replacement .

Jeff

 

[liya771]

Hi Jeferi,
I know what you are going through. Two days ago, I talk to my cousin's cardiologist and I asked her if she can let us see another doctor other thatn kaiser doctors. She said that she can give us permission but then the insurance is not going to cover it. well, money is a big issue for us and we don't know what to do.

My advice to you is that if you can afford, get second may be third opinion from other cardiologist. I can't tell you how careless some doctors can be.

I will keep you in my prayer.

Good Luck!

Liya