Medical Bureaucracy Trick

Posted: September 27th, 2010 | Author: | Filed under: Uncategorized | Comments Off

    Before you dig into this post, please let me first preface everything that I will write about today with stating the following: Overall, I have received the most excellent care, on nearly every level, from every single doctor’s office I’ve been to in regard to my breast cancer. I have been blessed with being in contact with competent, compassionate and humorous doctors and their wonderful professional staff.
    What I’m am writing about today, however, is about just one particular glitch I’ve recently run into. Today’s blog is not meant to be taken as my personal platform to spew venom upon any one individual office employee of any particular office. Therefore, I’m not using any real names, nor, will I specify which doctor’s office my stressful experience took place with. I am honestly just going to relate what I went through last week and what I’ve constructively learned from it, when all is said and done … in the hopes that it might help you, or a loved one, if you should ever find yourself in a similar situation.

    Last week for me was, well, hell … It was a week that summoned up the fury and ire of my Irish fighter’s heritage that dwells deep within me — it’s not a place within myself that I enjoy going to anymore. I’ve worked long and hard to tame that aspect of my personality. But, after feeling like I was being given nothing but an office level insurance bureaucratic runaround, to the point of feeling like I had nearly had a slick move pulled over on me — I was left feeling like I was literally having to fight for my mortality’s best interests.

    I debated writing about this experience at all. But, after much inner deliberation, and then upon receiving encouragement to do so from several friends who have worked in the medical field themselves — I’ve decided that sharing my experiences of last week, and the lessons learned from it, should be shared.
    There is an office level “medical bureaucracy trick”  that might save someone else ever having to experience the levels of anger and life threatening fear that I went through last week.
    Before going into any details of my story, right up front, here’s the trick … when an employee in a doctor’s office states that an insurance company will not cover what it is you are asking to be done — when they tell you stuff like, “I don’t know if that’ll be covered or not,” or “I believe they’ll refuse to cover what you’re asking for,” — calmly say the following:

“Please have my doctor call me at his/her earliest convenience.
I prefer to speak with them directly about this matter. Thank you.”

    Don’t plead your case with the office employee any further, don’t bother with explaining the logic behind  what you are requesting. Just insist upon speaking directly with your doctor about the matter, period. And, if need be, call back to speak to the receptionist and tell them also “Please have my doctor call me at his/her earliest convenience. I prefer to speak with them about a medical matter directly. Thank you.”

Let me repeat the trick, calmly state …
“Please have my doctor call me at his/her earliest convenience.
I prefer to speak with them about this matter directly. Thank you.”

    I’ll do my bet to condense the phone mishmash story of what I went through last week.
    I guess you could say that I refused to take no for an answer … as to my choice on how I wanted to surgically approach fighting for my life against breast cancer. I am opting for a bi-lateral mastectomy being done, that means, removing both breasts and then having implants for my breast reconstruction. In another post I will explain the reason(s) and logic behind my choice.
    This particular blog piece, however, is mainly about how to save you, or a loved one, the emotional hell I went through last week in fighting for my right to have a bi-lateral done.

A case of “Phone Mishmash” caught in the act?

    A well meaning employee at one of my doctor’s office’s didn’t “believe” the insurance company would cover my bi-lateral choice. A lengthy debate ensued in this first go-around on the phone with them. I pleaded the logic behind my decision for a bi-lateral with the employee. They remained adamant that they didn’t “think” the insurance company would cover my choice. They even went as far as to say they didn’t even think the insurance company would cover the reconstruction of my left breast (reduction and lift) if I did indeed only ended up getting a singular mastectomy! (Yes, they got an earful of my “walking around with a 22 year old right boob and a saggy 52 year old left boob” speech.)
    After my speech, I finally stated that this whole matter needed to be discussed with my doctor — and/or, at the very least, the insurance company. For sure, the whole issue of insurance coverage of my opting for a bi-lateral, instead of just a mastectomy, needed to be settled before my surgery.
    Needless to say, I hung up the phone in tears. I felt like I was being robbed of my right to choose how I wanted to fight my cancer. I was the most angry, afraid and confused I have ever been in my whole life.
    Two days later, Wednesday … the employee called me with a surgery date for a mastectomy. I was jotting down all the info into my calendar, I wrote “mastectomy” on the date. Then I asked, “Wait a minute, you mean for my bilateral, right? Is this date for a mastectomy or a bilateral?”
    The employee informed me it was for a singular mastectomy. Now we launched into a new huge discussion about breast cancer insurance coverage and my rights as a breast cancer patient. (I had made a few phone calls to see if I really was able to choose a bi-lateral and have it covered — told ya I was cutting this long story short.)
   I did my best to contain my ire, I really did. But, catching that one word difference, well, that’s when I got to feeling like a slick move was trying to be pulled over on me … see if the patient catches the one word difference or not. I can’t imagine this employee purposely doing that — she has always been very kind to me. But, nevertheless, I was still emotionally left feeling that way.
    If I hadn’t of caught that one word difference? I would have arrived at the hospital fully expecting a bilateral to be performed that day — only to find out I was getting a singular mastectomy. And, I’m betting it would have been one hell of a fight to get the left breast done after the fact.

Hot dang! A Firecracker Queen!

    This is where I’m cutting the long story even shorter … I clearly restated to the employee that I wanted a bilateral mastectomy, period. We hung up the phone with the whole matter still hanging in the air. I calmed down enough to harness my anger into thinking through a logical workaround to this given situation … Think like a warrior.
    So, I called “Ms. Firecracker” at the other doctor’s office that’s been involved in my breast cancer surgery. I had dealt with her before, when we were first going to do a mastectomy — before it got changed to a lumpectomy at the last minute.
    I explained to her that I wanted the mastectomy surgery to be changed to a bilateral mastectomy. She assured me that this would indeed be covered by my insurance company — that it’s my right as a woman with breast cancer to choose what route I want to take in fighting this disease and, how I want to approach my breast reconstruction too. Her reassurance left me feeling like I had been tucked under a wing.
    When I asked her what pseudo name she’d like for the blog she wasn’t sure of what name to pick. I asked her if I could suggested one to her, based upon how I’ve come to see her … as a firecracker. She’s professional, on the ball, has a great sense of humor, but mainly, I doubt you’d wanna mess with her.
So, Ms. Firecracker she is!


    Again, I’ve related this personal story to you not to rip any one office employee in particular apart. I have related it so you can save yourself, or a loved one, what I went through. There is no need to argue or debate your route of treatment choice with any medical employee. Ask them to check with the insurance company for sure and/or to speak to the doctor. See what the doctor has to say about it all and then go from there. No one needs the extra stress of going round-robin based upon “I think” or “I believe” statements, you as the patient nor the medical employee.

The trick is worth repeating one more time …
“Please have my doctor call me at his/her earliest convenience.
I prefer to speak with them about this matter directly. Thank you.”
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