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RvUsa

RvUsa

Well-known member
Joined
Mar 20, 2009
Messages
69
Location
Darlington, Pa
I got my second rejection letter from my final appeal on going to the Cleveland Clinic. :( So I got a second opinion from the ONLY one that the insurance will pay for, unfortunately, he is the partner of the 1st guy I went to see, so it was kinda like listening to a parrot!!!

He said 5.4cm is not emergent, and because of my size that I had a big aorta to start with, and my BAV wasn't bad at all. He also said that you guys were ALL WRONG, and I should not be asking advice from people with no medical knowledge!!! :eek: Imagine that, a doc who is threatened by a well informed patient. I asked him what their criteria for surgery was, and he said 5.0-5.5cm depending on the situation. He also said I have a ZERO percent chance of it rupturing, or having any problems.

So I guess I have fought the good fight, and will proceed with the WLS and pray for the best, I will let you all know how that is going, but dang its good to see you again!
 
Okay, so I'm not the sharpest tool in the shed, but.....
if your 5.4 is not emergent, but their criteria for surgery is 5.0 - 5.5, don't you fall into their range?
 
Tell the doctor you would like that statement put in writing, signed by him and then notarized just for the security of your family should something happen. I don't understand a doctor who is 100% certain in denying surgery to someone with a 5.4 cm aneurysm? Were you forced through your insurance to see the partner for the 2nd opinion? Which makes no earthly sense.

If you can, I would seek another opinion. I believe you can send your records to Cleveland for a "2nd" opinion without going to see them. A few years ago I think the cost was about $500. Someone can correct me if I'm wrong on this.
 
Karlynn said:
Tell the doctor you would like that statement put in writing, signed by him and then notarized just for the security of your family should something happen. I don't understand a doctor who is 100% certain in denying surgery to someone with a 5.4 cm aneurysm? Were you forced through your insurance to see the partner for the 2nd opinion? Which makes no earthly sense.

I think this is a great idea and I'm absolutely postive there is no way that Dr. is going to put that in writing. If he does, I wouldn't want him to do my surgery because he isn't too bright.

So, does your insurance plan only have one cardiac surgery group on their plan? That is just crazy! Have you talked to a weight loss surgeon yet? Are they going to be willing to do the WLS with your aneurysm? I'm sorry you that you seem to be stuck between a rock and a hard place.

Kim
Click to expand...
 
I agree: have them put that indefensible statement in writing. At the very, very worst, it can help make them pay for your family's needs later.

If that were true about the size of your aorta, the AMA/ACC would have a sliding scale for determining when aortic aneurysms need to be surgically corrected, instead of a single size standard (the one he told you, which you already fit). They simply don't want to be responsible for doing the surgery with you at your current size.

By the way, they should look it up on the AMA or ACC website. But then, I suppose the folks there have no medical knowledge either...

There is no "sacred learning" that only the doctors get to see. While certainly the medical education helps to put information into a context for understanding, much of it is just like English, science, or algebra - just facts. The days of the physicians' mystique are past. There are still many great doctors around, but they are real performers, not magicians.

Best wishes,
 
John's insurance is very limited because his wife works for a hospital and it is limited to their providers, as long as they provide the service, which they do. This is pretty common for employees of hospitals. The system she works for is actually well respected.

I really can't imagine any doctor saying that there is a 100% chance of no rupture because that's not true even for someone with a tiny aneurysm. I believe that your doctors think your weight is a significant risk for this surgery, and I agree with them. As I've said before, I personally know two people who died during heart surgery due to severe obesity. You have been fighting the system for some time now. Have you done what the doctors suggested and begun to lose weight? It's not easy, but if my doctor gave me the ultimatum that yours has given you, I would certainly work on it.

However, if you really want an opinion from CC, you can send them your records. For peace of mind, it should be money well spent.

It's time to stop fighting the system because that's just causing frustration, and start doing something for yourself. Pay to send your records to CC, lose weight, get the surgery you need.
 
Wow, this is very frustrating. A second opinion should be with a completely different group of doctors, not someone within the same group. You should dig deeper to see if there are any legalities that can support a second opinion that would force the insurance company to pay.

It's a bit scary to me that a doctor would be discounting a well informed patient. Hang in there and continue to stay informed.
 
There was a story on Weight Loss Surgery on the News (ABC I think) this week.

Not surprisingly, they noted that Surgical Outcome correlates with Volume of Patients treated, i.e., the More they do, the Better they are.

They cited a 67% increase in 'incidents' (I forgot exactly what type of incidents they considered) when surgery was performed at Hospitals that had a Low Volume of patients (specific numbers were NOT given).

You may (or may NOT) want to ask how many 'weight loss surgeries' your Surgeon performs per year and what his Morbidity and Mortality numbers are...

I'm guessing the Insurance Company doesn't really care what his numbers are (other than the Number on his BILL to THEM).
 
RvUsa said:
He said 5.4cm is not emergent, and because of my size that I had a big aorta to start with, and my BAV wasn't bad at all. He also said that you guys were ALL WRONG, and I should not be asking advice from people with no medical knowledge!!! :eek: Imagine that, a doc who is threatened by a well informed patient. I asked him what their criteria for surgery was, and he said 5.0-5.5cm depending on the situation. He also said I have a ZERO percent chance of it rupturing, or having any problems.
Click to expand...

Feeling a little threatened was he? Out of the mouth of babes. I side with the others that you need them to put that in writing, get it all legalized and see if they don't change their tune. If they won't put it on paper and give it to you, they're admitting guilt right there.

I love it. We've all been through this surgery and yet we are without medical knowledge. HORSE CRAP!
 
As soon as he said that, I thought, "Ross will have a field day with this" lol.

Thanks everyone, I just am so frustrated, I have talked to an attorney, he said that I'm screwed, you guys say I'm screwed, heck even my wife says I'm screwed, but I am just banging my head against the wall. Maybe this is the way it has to be, and I should just move on.

Sorry I come here and vent, but I figure most of you understand. :(

The WLS center I am going to is a center of excellence, but not the one I wanted to go to, the one I wanted to go to wasn't covered by my insurance... GO FIGURE. That one is in UPMC, but not in heritage valley part. They are rated one of the top centers in the east. The one I am stuck with is ok I guess, I have heard some bad things about it though, and that has me a little worried.

I guess we will see how it goes.

thanks everyone

John
 
Well John I'll just have to talk to the man about it and have him keep you safe until you can have the surgery. I think he still listens to me. (Sometimes?)
 
I am completely stunned and will add my voice to the others saying GET THIS STUPIDITY IN WRITING!

I worry about my aneurysm and it's only at 4.5 cm, so I can just imagine what you're going through.

Best wishes and keep us posted.

Cheers,
Michelle
 
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