Surgery/Insurance Question

June 25, 2001

Hello everyone! Hope all of you had a good weekend. Mine wasn't the

best as far as the Chiari goes. My headaches seem to be hitting me

with a vengeance again. I'm wondering if this is due to the stress

I've endured in the last month with my mom's health problems. Some

of you are aware of what I'm talking about. Oh, well. . .life must

go on. Hopefully, the pain will subside some. I must think happy

thoughts. . .

Well, I'm getting close to asking my HMO for approval of the surgery

with Dr Oro at the Univ of Missouri. They are still denying coverage

for my consultation with him but I wanted to get started on the

surgery approval, in case it takes forever! (okay, I'm exaggerating

but when we suffer with Chiari, it seems like forever, you know what

I mean) So far they're telling me their centers of excellence can

treat me. I've already been to one of them & was told they wouldn't

do surgery on me unless I had a syrinx.

I've been assigned a case manager with my HMO so I plan on submitting

the letters, etc instead of my PCP (I'm not sure my PCP's office

staff would fax all the information I want them to).

I plan on submitting Dr Oro's written letter of my exam at my

consultation appt, a letter Dr Oro wrote explaining his level of

experience & a letter from my local neurologist to my PCP in which he

states, he thinks it's a reasonable decision for me to undergo the

Chiari surgery based on my symptoms. Although, due to some of his

wording, I wonder if parts of his letter might work against me.

Specifically, he states, that I described symptoms of trouble

concentrating & thinking along with a poor memory. But further on in

the letter where he gives his findings of his examination, he

notes, " her memory seems adequate without any problems concentrating

or thinking, at least by a preliminary neurologic investigation " .

He ends his letter by stating, Dr Oro is considering a surgical

decompression & he thinks it is a reasonable approach to my treatment.

What do all of you think? Do you think an insurance company could

misinterpret his statement above which I have in parenthesis? Do you

think they'd think I'm making this up?

Thanks for your advice,

in OH

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