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Old 08-16-2010, 06:06 PM   #1
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bkc888 HB User
Dealing with Medicare HMO and Colon Cancer

I wish I found these forums earlier.

This is regarding my grandmother who was recently diagnosed with colon cancer about 12 days ago from a colonoscopy. She is 77 with HMO medicare. She did not tell me about the reports until 10 days ago on a Friday night.

When I first saw the report 10 days ago I was panicking and frantic in finding a specialist available for her as I assumed time was very important. All the while hiding my tears and panic from her to keep her calm. The rest of her family are away and I am the closest relative.

Her primary care physician that she really trusts was on vacation and the substitute physician referred her to a General Surgeon Dr. P. I had called to receive the Authorization for Dr. P 10 days ago but unfortunately was not able to make an appointment on that Friday night. I was very angry when I called to the Dr. P's office as a person picked up but refused to open her scheduling book. I called over the weekend as well and same story. I had to call during normal business hours to schedule her in.

So I called my friends that are doctors and med students and they referred me to a colon specialist Dr. K and was able to make an appointment the following Monday. I was able to argue with the HMO to switch authorization to this specialist ASAP same day.

We saw the colon specialist Dr. K 7 days ago and he said he needs to operate on her and will put in an authorization from the HMO for the surgery. I asked him if she needed an oncologist privately so that I don't scare my grandma and he said he does not know until he operates. He said the authorization will take around 5 days.

After 5 days I found out that the doctors office have not even submitted anything yet to the HMO for approval after calling the various departments of the HMO. I was getting frustrated and angry at all the bureaucracy. I was able to push the doctors office to submit the form the same day Friday Night. It takes the HMO 2 days to review urgent approvals.

Fast forward to now which is today. I took my grandma back to her primary care physician (Dr. W) that just came back from vacation.

Dr. W was adamant in us seeing Dr. P instead of the Dr. K. My grandma thinks her primary care physician (Dr. W) is very credible and would listen to anything he says over anyone else's advice. So we now have to go through the process of HMO approvals all over again with Dr. P.

It will take 7 days before my grandma can see Dr. P as he is very busy. This was after our Dr. W spoke with the office directly to make this more urgent. I could imagine trying to schedule a surgery date with Dr. P.

When I first saw the report I was panicking in finding a specialist right away. But through research and friends I know that a few days will not hurt. But I also want to make sure I do everything I can so that my grandma can get what she needs fast without hurting her in the process.

What should I do to improve this battle with HMO? I am usually not this aggressive in pushing people to get things through bureaucracy but my grandma has cancer.

Thanks in advance.

 
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