› Forums › General Melanoma Community › Denied Referral
- This topic has 15 replies, 11 voices, and was last updated 4 years, 9 months ago by
MelanomaMike.
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- July 20, 2019 at 4:24 pm
Well, Hurdle # 3, Referral Denied and i get the reason why, the Review Board guy i spoke with said to me because my Onco didnt file it and that ” I” did it through Kaisers Member Services, it doesnt hold weight without a treating physician co-signing it, i have a Plan C though, since i stopped working, (i had Kaiser thru my job since 2003) when i left, i signed up for our Medi-Cal program “LA Care” (Calif’s State/Fed health program) wich had Kaiser and a few other health providers, i obviously chose Kaiser so i could keep my same account, team and treatment. According to Dr. Hamids coordinator he takes straight Medi-Cal so, worst that could happen, i can stop Kaiser and ask to be on “straight” Medi-Cal, the only thing is, to transfer back could take time, maybe i can get it expedited cuz of my health. Ill call Monday morning to find out my options, i really want Dr. Hamid to treat me! That other doctor, Dr. Jang (the Kaiser Onco im to consult with Aug 15th) is not a Mel spc. and hes to far away if im to have supportive visits during “his” inpatient treatment, that alone is a deal breaker, i wanna feel good about inpatient treatment!!!..Am i being to picky at a crucial time? Im just so confused at this point, it makes me sick….any advice or knowledge about this would be appreciated …
Hope ya all are having a relaxed weekend!
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- July 20, 2019 at 5:42 pm
Sucks that you have to deal with this bureaucracy on top of the melanoma. Too picky? Nope. Dr. August 15 is far away AND not a melanoma specialist? Nope. Did the review board comment on whether your substituting onco can file it based on your recent results? Does Dr. Hamid’s coordinator have any tips on expediting the Medi-Cal process? Don’t let ’em getcha down. Keep us posted. Sending big hugs.-
- July 20, 2019 at 6:11 pm
I don’t think you are being too picky either. Dr.Hamid is your best fighting chance. Mel specialist is the only way go. GET the best care you can access. Your mental state will help you through the next round of treatment so it better be strong, happy and confident…ahh but you know this…you have been telling all of us this. Have a drink…blow off the anxiety with whatever works for you and make that call Monday. Write out exactly what you want to say ( I have mega fog from Nivo and past clinical trial) and tell them your preferred plan. You go Mike!!
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- July 21, 2019 at 12:04 am
You’re absolutely not being too picky. We had to leave Kaiser when they would not give my child physical therapy after she had a stroke during birth and was not developing at the proper milestones! That experience combined with yours has hardened my decision to make sure I don’t have Kaiser during retirement. It’s saying something that you can potentially get better care through public health than through Kaiser. It’s terrible that you have to go through the bureaucracy and paperwork at a time you need support, but you have the absolute right to access the care you need. This kind of stuff makes me so angry. Like everyone on this board, my thoughts and support are with you. Hope the weather in LA is fine right now. -
- July 21, 2019 at 1:59 am
Thank You guys, to answer IKB question, yes, that “substitute” oncoligist Dr. Fowler who is filling in was aware of my “referral” and turned the other way obviously, she probably doesnt wanna lose “Money” by having me see and be treated by a non Kaiser doctor thats the whole real reason anyways im thinkin…
And thank you DoubleTT And Quiet Poet, your the best! And yes, the weather has been ok lately, under 100!! Next week itll heat up!….
Boy, its been a rough day for me, “and” my wife Hillary, we take care of 3 feral cats (besides our house cat Whisky) one of the 3, Grumpy, we had to put to sleep today, he had severe Cryptococcous (spelling) in his mouth, lungs etc and he wasnt doing good…it didnt feel good playing God ill tell ya that….hes not suffering anymore, trying to trap him took weeks & we FINALY did it, thank god…not fun to deal with while im dealing with my stuff, but i feel better now that hes resting, i really love cats AND im a hetrosexual!!… take care yall… -
- July 21, 2019 at 10:43 am
Goodness, Mike. I am so sorry!!! You’d think being tortured by melanoma would be more than sufficient, wouldn’t you??? But, no! Gotta deal with jerks and a jerky system on top of it. Can your actual onc not complete the referral request? I know you were trying to get this done quickly since they were (I seem to remember) unavailable….but at this point, are they available to do it? So….I would see if that was an option. And YES!!! Call Monday on your own to Hamid’s office!!!! Sorry you have to coordinate your own care, but what choice do you have?Sorry about your extra kitty being ill. However, you did the kind thing. My daughter just took in her second stray kit-kat. Critters get into our hearts every time, don’t they? Hang in there. C
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- July 21, 2019 at 9:49 pm
Hi MikeAm sorry for all this. I agree with Celeste in that it might be faster if your existing onc would put in the request to see Hamid, rather than starting all over again.
But of course you should call Hamid directly and see what his office recommend as to what is the fastest way for him to be able to see you.I have relatively good US insurance and I dont know how the US system works, but if you drop Kaiser and start again, will this cause more delays? Ask Hamid’s office and they will guide you as to what to do, I think (hope!)
good luck Mark
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- July 22, 2019 at 12:17 am
Mike, you might want to talk to one of the insurance coordinators at Angeles Clinic (Hamid’s office). My wife sees him and they’ve always been helpful. They might know a trick or two that Jasmine isn’t aware of. Those folks will bend over backwards to get you in to see the doctor, in my experience. Good luck.Dave
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- July 22, 2019 at 7:03 pm
Hi Dave, and Anonymous, I’m glad to hear there are more and more folks being treated by Dr. Hamid, can I ask, the Angeles Clinic is only an Outpatient clinic correct? (hence the name “clinic”) and what about the other folks who are doing Clinical Trials and or inpatient type therapy’s, arn’t they in a bigger hospital? Arnt clinical trials usually an Inpatient program? I know hes part of Cedars Sinai…any info on this would be appreciated, I’m waiting for a call back hopefully soon! -
- July 22, 2019 at 7:47 pm
Hi Mike, I believe that most clinical trials are run on an outpatient basis. Obviously, if the trial involved surgery, that might be inpatient, and there might be other situations where they would need you in a hospital bed, but mostly I think they are outpatient. As you noted, Angeles is affiliated with Cedars Sinai (our bills always come from Cedars), so they have access to a world-class hospital if needed. They have an imaging center right there at Angeles (and I believe a lab, though my wife has always done here labs here close to home – we live about 4 1/2 hours from Angeles). Dr. Hamid is really great, I hope you can get in to see him soon. Dave
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- July 22, 2019 at 3:24 am
Mike, I second Dave’s comments. My husband is also being treated at The Angeles Clinic. Jasmine along with all the treatment coordinators are wonderful and compassionate. From experience we have found them to have a lot of knowledge and ways with expediting referrals using coordination with their billing/referral system out of Cedars Sinai. Sending all positive your way! -
- July 22, 2019 at 3:42 am
Hey Mike,I agree with two things: being treated by Dr. Hamid and asking onc for referal(I’ve recently been watching videos with him talking about latest thoughts about melanoma and I agree with Celeste and others, take the path of least resistance if possible and see if your onc will just write referal). I had to call MD Anderson about a referral for adoption after husband was diagnosed and sometimes just asking does the trick. They should be able to write this up for you.
Let me offer you this as well – I will gladly call anyone up at this point and go “TERMS OF ENDEARMENT” on any health care workflow at this point. Think Shirley Maclain demanding the pills for her daughter, that is how I behave at this point. As I was telling my husband recently, I have lost my tolerance for this type of minutiae and ridiculousness of these systems. I’ve often thought about creating this type of “service” for others. Just being a neutral 3rd party system for those on this board that is willing to completely lose it to get stuff done 🙂
We’ll get you to Dr. Hamid, come hell or high water.
Cheers,
Jackie -
- July 22, 2019 at 5:56 pm
Hello again!Just want to lay this out in rather “legal” format, cuz this is what I see:
1) KP staff electronically (via email) canceled your scheduled surgery – a standard treatment for cancer that THEY recommended/initiated/scheduled – without providing an alternate course of treatment.
2) KP staff electronically cancelled your Immunotherapy sessions – another standard treatment for cancer that THEY recommended/initiated/scheduled – without providing an alternate course of treatment.
3) KP staff sent a consultation appointment for over 5 weeks away (Mel waits for no one!) with a Dr. who is outside the distance (30 miles) guaranteed for treatment. (This is part of my KP plan, and I’m told it is part of all KP plans, but I don’t know that for sure.)
4) After not providing a consultation, course of action/treatment plan, or any other guidance for their next steps for your health, they refused to refer you to another practitioner (what’s the distance? Is Hamid closer than Jang? If so, that is GREAT!) because the request came from the “wrong KP source”; and they did not provide guidance or contact the ONCO who may be the “right KP source”.
Honestly, gather all those details as well as the TIMELINES that you have seen your mel progress (for me, 24 hrs for a lymph node to flare from nothing, then 3 weeks to go from 14mm to 22mm – growth rates mean “time is of the essence”.)
Draft a letter with all that info in a “here’s my cancer NOW”, “here’s what my Drs did about my cancer NOW” “here’s what they didn’t do”, “Here’s what they won’t do”. Include a clear directive of what you want the Ins board to do – something like “Due to the aggressive nature of Melanoma, and the specific molecular makeup of my strain (include mitoses counts/rates if they indicate a particularly aggressive cancer), I’m asking the Cali Insurance Board to intercede on my behalf to and request that KP immediately approve a referral to Dr. Hamid, a well known Melanoma specialist, as a valid treatment plan to address my Stage 4 Melanoma is urgent to my survival.”
Don’t soft pedal it, and don’t play nice. Don’t be mean, don’t rant, just state facts/figures/dates/ needs, expected action. Send it to the state Medical Insurance Board (here’s the one for Cali: http://www.insurance.ca.gov/01-consumers/101-help/ ) CC (included names at the bottom of the letter) the Drs who cancelled treatment, the Head of Onco and the Medical Director at that facility, and the KP legal department. Use your lawyer if you have one – it’s worth the $150 bucks for him to copy/paste your letter onto his letterhead and do all the “return receipt” mailing.
Then email your Onco in the KP.ORG chart and upload a copy of the letter, saying that hard copies have been sent via Certified Mail to all parties.
I’m betting that once you do this they will be GLAD to refer you out, as they won’t want to take on the legal hassle, and incur the RISK of NOT doing it!
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- July 22, 2019 at 11:53 pm
This is a great summary of how to advocate for yourself with this medical HMO system. I’m sorry Mike that you have to work so hard to get the care you need and deserve. Sorry about the kitty on top of everything else you are going through at the moment. I wish you all the best and I hope things work out for you very soon!
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- July 23, 2019 at 2:54 am
Thank you for the great support!I wish I had all you guys here with me, we could ALL be treated by Dr Hamid and all be together, I found out that, to go back to straight Medi-Cal, it can take up to 45 days, on average 21 days and that’s IF IM Approved! Aaaahhh! So, plan F (I’m up to plan F now!) Wait and see Dr. Jang out in Riverside and beg him to write the referral for me to see Dr. Hamid a MELANOMA SPECIALIST! Jang is not! I’ll tell him, “why would I trust a “non” specialist if I’m at the end of the line?””” Especially after my current team QUIT ON ME! I’m gonna tell him, no disrespect to you, but i want a Dr that KNOWS Melanoma!. I hope I leave with a referral, cuz I WONT leave till I see him typing it up!.. Aug 15 is D-Day troops! I’m getting what “I” want, not all this quitting on me BS!!!…you guys rock!! ALL Of you who replied on this matter, I feel the love BELIEVE ME! take care guys…
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