Fed up with current staff, considering MSK

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mpbser
Posts: 496
Joined: Wed Apr 19, 2017 11:52 am

Fed up with current staff, considering MSK

Postby mpbser » Tue Aug 07, 2018 8:58 am

OK, so every time I have had to arrange scheduling or prior authorizations with my husband's oncologist's assistant, "DP", I have had to phone her over and over and over and over. Since we are going there from out of state, if prior authorization is not obtained, we are responsible for the costs. Otherwise, if this was an in-state procedure, the provider would be responsible for their negligence in not obtaining the prior authorization. I am at my wits' end with her right now. I started the process of asking for my husband to have an MRI instead of CT at least three months ago after my husband had his most recent appointment with his oncologist. Unfortunately, I was unable to be there. His doctor changed the scan frequency from his original "every three months" to "every six months." When we originally met with him and the liver surgeon I asked them what they normally used for surveillance scanning. I recall that it was MRI, and I was pleased because that is also what the liver surgeon in Albany, NY we went to for a second opinion had said. I would have spoken up and questioned at this most recent visit. I did so via email to the oncologist's other assistant, "AG", a Nurse Practitioner who was been totally awesome from day one. I explained to her that I was concerned about using CT because 1) none of my husband's CTs (or the PET) ever detected his liver masses and 2) he takes curcumin which apparently can interfere with the CT contrast. After about a month of emailing about this, the doctor approved an MRI order June 6th. I was supposed to hear from DP but after about a week of waiting, I called DP to schedule the back-to-back appointments for MRI, labs, then oncologist. She actually got back to me relatively quickly, after a few days, without me having to call her repeatedly.

Now, the doctor is only available for appointments two days a week and the follow up is recommended for November. Radiology appointments are not easy to get at Mass General, so all of the time slots that would work for us (midday since we have to travel 4 hours each way) in the month of November were unavailable except one at the end of the month: November 27th. Since prior authorization is needed, a week after the appointment was booked, I started checking in with our insurance company to see if a request was initiated. It wasn't, so I checked in a week later and it still wasn't. I checked in a week after that and it still wasn't. To this date, DP has not started the process.

Maybe it's because I have a Motion for Summary Judgment due October 1st, with responses due October 29th, sur-replies due sometime in November, and a hearing on the motion on December 11th that has me really anxious about this. Or maybe it's because if the MRI is denied, we have to go with a CT, and that means rescheduling everything. Given what an ordeal scheduling can be, I think it is reasonable to expect the prior authorization to be processed as soon as possible.

Before my husband complains to the doctors (no one wants to get on his bad side as he can be vicious), I am ranting here. I am going to take the above, copy and paste it, and finesse a complaint draft for him out of the contents.

Oh, yeah, due to all this BS, I am considering suggesting to my husband that we look elsewhere for follow-up surveillance. I'm wondering what those patients of Dr. Kenemy have experienced with surveillance/monitoring in regards to situations like the above.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED

mpbser
Posts: 496
Joined: Wed Apr 19, 2017 11:52 am

Re: Fed up with current staff, considering MSK

Postby mpbser » Tue Aug 07, 2018 4:15 pm

UPDATE: An exceptionally diligent customer service representative from our insurance company just called me today to discuss our "case." She has been monitoring the status of the prior authorization request and wanted to learn more about why it is so important to get it so soon. In the course of the discussion, I learned that some Radiology departments put orders in for tests that stay open for only 60 days. She said that she looked at my husband's history and saw that the last CT scan was "open" for 60 days, so it looks like that is what they do at Mass General. This means that it would not make sense to put in an authorization request until the end of September, I think. I'm not sure I understand why, but I think the 60 day window has something to do with it. The rep will be calling me on a periodic basis so the next time we speak I will ask for further clarification.
Wife 4/17 Dx age 45
5/17 - Lap left hemi
Adenocarcinoma
5 x 4 x 1 cm
low grade
T3 N2b M1a
Stage IV A
lymph nodes: 9 of 54
8/17 Sub-total colectomy
2nd tumor 5.5 cm T1 N0
CEA: 1.4, 2.1, 1.5, 1.9, 1.9, 2.1, 2.1, 2.4, 1.7, 2.0
MSS/MSI-L
Lynch no; KRAS wild
Immunohistochemsistry: Normal MLH1, MSH2, MSH6, and PMS2
Tumor DNA variants: MTOR, APC, TP53
Liver left hepatectomy seg 4 1/31/18
5/18 NED


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