Friday, November 14, 2008


While waiting for my echocardiogram appointment (for an hour and a half), I decided what better time to make phone calls to Stony Brook. I get switched over to 3 different people only to find that the person I need to book the MRI guided biopsy with, is not available until Tuesday. I then call Colleen who gives me the number of the head RN at the Breast Center. She tells me they'd probably have me come in as a new patient to be evaluated with all the films and reports I currently have. She suggests I go back to Medical Arts Women's Imaging for the procedure. Then, if the biopsy comes back suspicious, I can bring everything with me to Stony Brook and meet with the breast surgeon.

I call Medical Arts. They give me an appointment for this Thursday, Nov. 20th. They just need the script from the doctor and an approval from my insurance company. I call my primary care physician and tell the receptionist what I need. They call me back and leave a message on my cell phone. While that's happening, I am getting my echocardiogram--the tech actually checked two other places that have never been checked before--one was the carotid artery and the other was the place where your ribcage comes together.

I call the primary back. They say that they can't order the mri guided biopsy, so they can't call for authorization. The doc just wants me to get evaluated over at Stony Brook. UGH. I call back Medical Arts, crying. They tell me that I should call my insurance company directly and the fact that it says 'bi-rads 4 suspicious abnormality' I should have no problem getting authorization. She asks me to try to calm down and to call back if I need further assistance. I cry all the way home now wondering what bi-rads 4 means.

I get home...still I can't even dial the phone because I don't know what my voice will sound like when someone answers. After calming down and explaining why I'm crying to a sympathetic Cassie, I call the insurance company. I get disconnected 3 times. On the 4h try, I speak with someone who wants the insurance code for the procedure and the referring doctor. I tell her I don't know the code and my ob/gyn, who should be the referring doctor, is out of town until November 24th...I start crying again. She tells me to call Medical Arts Imaging and get the code from them. I call and get put on hold while they try to locate the person who I was speaking with earlier. Ali texts me to pick her up and I, frustrated, hang up the phone and drive, while sobbing at times, to get her.

At this point I am beyond done. I think to myself, maybe I need to take one step back before I can move forward. While waiting for Ali to come to the car, I put in a call to Stony Brook and leave a message. Ali looks at me and I start crying again. She volunteers to drive and I'm more than happy to hand over the keys.

When I get home, I'm calm enough to call Dave. He says, "Why don't you call the ob/gyn's service and see what they have to say." I think, why didn't I think of this in the first place? I call and give as little explanation as I can to the girl on the other end. I tell her I need an script from Dr. Loy to get the procedure done, as well as an authorization number from Empire. I give her my numbers to call if there is a problem and tell her the date and place of the procedure to give to Annette when she comes in on Monday (the office staff is there checking messages everyday).

Stony Brook calls and I tell her my plan of action. I have decided that, if there is a problem with getting the script and/or the authorization, I will be getting all of my tests and results (I have all except the rest of the MRI pics) up until this point and I will make an appointment as a new patient at Stony Brook. She said, ideally, I would have the biopsy report before coming in, but this could work too.



Miki said...

Syndee, I am so sorry that you are going through all of this. On top of normal worry and stress, the insurance company makes it worse. YOu are right, it shouldn't be this hard! If you need to scream, call me....been there, I know what you are going through. Did it with Scott, and yes, it is frustrating.

mamakin said...

We don't know each other but for some reason I found Robb & Lisa's blog through Ravelry (knitting/crocheting 'universe')a while ago & was compelled to read every entry. Since I had an accident and two spinal surgeries with hardware in addition to 3 other operations in a 5 yr period,ongoing pain & lifestyle changes, I really was struck when I first saw the xrays of Robb's spinal hardware - It looked like mine, only higher. I've been dealing with this since a 2000 car accident. So I started to follow the blog, which gave me hope. Today I stopped by & saw the stunning photo of the bee Lisa took & also noticed your comment. It interested me, so I clicked & found you. Now I've been reading your blog. I want you to know how brave I feel you are;not just that you go through every day trying to maintain a 'normal' life, but also because of how vulnerable you are & how you document your experiences, good & bad. So many women hide the experience of dealing with cancer. You are helping everyone who comes upon your blog & gives them strength regardless of what they're going through in their lives. I had a cancer scare many yrs ago when my kids were young but I was very lucky that they removed the piece on my neck in question & needed nothing else done. I've also learned that we live fairly close to each other, a strange thing in the cyberspace world. I'm in Dix Hills. I'm going into Syosset Hosp Tues for a week trial of an implant to try to reduce or eliminate (I'm going for this one)the constant debilitating pain I'm in which has changed my life & that of my family. The final implant will be done the following Tuesday. My thoughts & prayers are with you as you go through your treatment and recovery. I don't know if you knit or crochet, but if you do, I'm mamakin on Ravelry, I'm just learning this computer stuff & am working on a blog which is mostly just knitting related but I can do it while laying in a bed :-) - it'll morph as soon as I figure it out with the help of my son, but here it is if you'd like to drop by & say hello-

Prior to my latest problem which has had me home-bound, I worked managing the front office of a Dr's office and got referrals all the time. Insurance companies are nightmares, but it's not your job to get the clearance for your procedures. You don't know the required terminology, medical coding & the ways to move a case faster through their red tape. It's taken hours for me to get clearances & I know what to do so my heart goes out to you when I hear that it was put on your shoulders,especially when you have to focus on getting strong & healthy again. If you get nowhere with insurance companies (& I've found Empire to be one of the easiest ones to deal with)you really should call the doctor's office & tell them your insurance company won't give you clearance because they want it from the Dr's office so that they get the correct diagnostics & procedure codes & reason for medical necessity. You're your only advocate so stay on top of them. Please feel free to contact me-even if it's to learn how to knit to relax lol.
My best to you & I hope to hear from you-especially good news!