- Need Your Help

[Guest guest]

Hi ,

Not sure how up to date you are with my situation, but I have

scheduled my esophagectomy with Dr. Rice at TCC for March 29th.

There's a long story behind the whole thing, which I won't bother

you with now. My problem now is my insurance company. I was reading

your story on your website and saw that you had some issues with

insurance as well when it came to TCC and was wondering if you could

give me any tips or anything specific that worked.

My PCP has already submitted all my records, including the most

recent test results and letters from Dr. Rice. The thing is, even

though he is out of network for my insurance, they had already

approved the initial consult, additional testing, and even the

myotomy (even though at the time they approved it, we weren't sure

if I was even a candidate for the myotomy - that is what the testing

was for). So now, Dr. Rice has determined I am not a candidate for

the myotomy, but that I need the esophagectomy. Here's the kicker -

we had already seen Dr. s in Rochester, NY, who said

the same thing, back in 2005, and he is in network for us. Back then

I hadn't done the research, so I didn't even know about Dr. Rice and

TCC, so we just went to Dr. s and his advice was such a big

step that we took some time to think about it and then did the

research. So, now the insurance company is basically saying that I

need to stay within network because there are doctors in network

that can do it. However, the funny thing is, they aren't even saying

I have to see Dr. s, they have now given me three other names,

and I'm like, whatever - I have never heard of or seen any of these

names anywhere....these insurance companies think we are so stupid

and that we don't have a clue about what's wrong with us. Anyway,

the initial medical director that approved Dr. Rice initially is not

the same one that has just denied this request. SO, we are preparing

our own letter (can't wait to get that one going....), and I need to

get my PCP to do more (he is out until Monday). In the meantime,

after reading your story about having trouble with your insurance

approving TCC, I was wondering what you did, or if there was any

special info you provided that helped push it over the edge.

Please let me know. I am freaking out - I have my head all set for

this huge surgery, and now we only have a couple weeks to get this

worked out. Anything you can suggest will be much appreciated.

in NY