At Sun, 21 May 2000, Helen Dynda wrote:
>
>[ I decided to re-post my message, because I find it difficult to read
>messages which extend beyond the space, which is allowed for them to be
>written. ]
>
>[] I have deleted a good share of Bev's adhesiolysis experience because
>I wanted to focus on the issue of how medical insurance ( in my case
>Medicare and supplemental insurance) can affect the way that doctors and
>surgeons choose to do business with their patients.
>
>At Sat, 20 May 2000, Bernie and Beverly Doucette wrote:
>
>[] MONEY AN ISSUE? INSURANCE AN ISSUE?
>
>" Because insurance company's across the USA have set rates ( ceiling
>rates ) on most surgical procedures...and they set a rate for that
>procedure based on what they think it SHOULD cost...so in a normal "
>Adhesiolysis " procedure, the usual rate across the board is about $2500
>total! Now that means that no matter who the surgeon is, or the facility
>where it is performed in, the insurance company will pay no more then
>that amount...no matter how long the procedure is, no matter how skilled
>the surgeon or reputation of the surgeon, that is the amount they pay as
>that is what they feel that particular surgery should cost. That rate
>is based on the amount of time and the " importance " of the
>adhesiolysis procedure.
>
>" Most insurance company's feel that an adhesiolysis procedure SHOULD be
>able to be performed in about 1.5 - 2 hours TOPS!!! Why? Well, as you
>know, MOST surgeons and DR's do NOT feel that adhesions in and of
>themselves are a disease or cause a problem...unless you obstruct...so
>it is their impression that a surgeon should be able to go in,
>laparotomy or laparoscopically, and simply slice them apart...but they
>also feel that it should be or is usually done in relationship to a
>cooperative surgery such as a hysterectomy, appendectomy or some other
>type of surgical procedure...and if you look and listen to other ARD
>sufferers, there has always been another reason or procedure done when
>they had an adhesiolysis...know why? Because the surgeon gets more money
>by performing another procedure with the adhesiolysis!! When they do a "
>diagnostic " procedure ( which is their way of being able to perform an
>adhesiolysis only ) they get paid very low rates for their time...and
>adhesions take time...so most Dr's do the 1.5 - 2 hour adhesiolysis and
>then close you up or take out an organ or do a resection etc.!! Not only
>will they not do a good job, but the hospital will not allow any more
>time for one as the money paid from the insurance companies is not
>enough to compensate for the use of the operating room, the
>anesthesiologist's time, etc...so everyone loses, mostly the ARD
>patient!!"
>
>- - - - - - -
>
>[] MY ADHESIOLYSIS EXPERIENCE:
>
>I want to share the experience I had following a diagnostic laparoscopy
>in 1997:
>
>After 27 years of seeing doctor after doctor after doctor...I finally
>found a gynecologist, who listened to me and sincerely believed that I
>was suffering from chronic pain. He told me that, from the description
>I gave him about my symptoms, to him my symptoms sounded like either
>adhesions or endometriosis...but he felt pretty sure that adhesions were
>the cause of my pain. He told me that only a diagnostic laparoscopy
>would provide the answer. This was the very first time I had ever been
>offered a diagnostic laparoscopy!!!
>
>So on August 1, 1997 I was scheduled for Same Day Surgery at a hospital
>in Minneapolis, MN. At the very beginning of this surgical procedure,
>my gynecologist had great difficulty in inserting the laparoscope
>through my navel, the usual first point of entry. Instead, he had to
>start the procedure just above the pubic bone.
>
>What was the result of my diagnostic laparoscopy? I had massive
>adhesions the full length ( 7 inches ) and 4 inches across the surgical
>incision from the laparotomy I had undegone in February 1970!! These
>massive adhesions had attached my omentum ( The omentum serves as a
>protective barrier between the intestines and the abdominal wall. ) to
>my abdominal wall...almost as if my omentum had been super-glued to my
>abdominal wall!!!
>
>I requested a copy of the video of my surgery; which really proved what
>my surgeon was up against. I watched the video and I was able to see
>the difficulty my surgeon was up against. Remember, this was a
>diagnostic laparoscopy...and he had to lyse these tough adhesions ( They
>were very mature because they were 27+ years old! ) before he could
>begin his examination of the rest of my pelvic organs.
>
>As he cut through these adhesions with the use of scissors ( which cut
>and cauterize at the same time ) I noticed that as a result of the
>cauterizing, the liquidized fat dripped into the pelvic cavity. I do
>not know if this substance is irritating to the pelvic organs;
>BUT...just before the surgeon freed the adhesions from my abdominal
>wall, I saw a really thick adhesion, which had a blood vessel running
>through it. When he cut through it, I noticed that it bled...causing
>blood to drip into my pelvic cavity. Blood is a known irritant, which
>can cause scar tissue or adhesions to develop.
>
>Because of the massive adhesions, I was kept in the hospital
>overnight...on intravenous antibiotics and pain medication. Other than
>the expected pain from surgery, I definitely felt better than I had in a
>long, long time ( 27 years ). I had such great hopes that I would be
>pain-free......UNTIL on the 10th day I began to feel the return of pain;
>but I did not get too concerned about it. Six weeks post-op I mentioned
>this to my gynecologist...but he did not show any real concern. Not
>being a very assertive person, I did not make an issue out of it...
>
>...until several weeks later when my pain level was beginning to get out
>of hand. Since I lived at some distance from Minneapolis, I wrote to my
>gynecologist to ask what he would suggest that I do...actually thinking
>that I would be given an appointment date. Two weeks later I received a
>call from one of his office nurses. She said, " No, the doctor did not
>want to see me!!" I asked if I could make an appointment...but again she
>said that the doctor did not want to see me. I was shattered!!!!!!!!!!!
>I could not understand why this gynecologist wouldn't see me.
>
>It took me almost 6 months to find out why I had been refused further
>care from this gynecologist!!! During those 6 months I spent alot of
>time on the Internet...participating in the Endometriosis Forum (
>http://forums.obgyn.net/endo/ ); because I needed a place where I could
>vent some of the frustrations and feelings that had come over me as a
>result of being denied care by my gynecologist. It was through this
>forum, that I learned the answer to the "cold shoulder" I had been given
>by my gynecologist's nurse ( who was acting in behalf of my
>gynecologist.)
>
>This is what I learned: Because I am a Medicare patient - with
>supplementary insurance. Medicare did not pay
>what my gynecologist was asking!!! My gynecologist had to accept what
>Medicare and my supplementary insurance paid him...and then my
>gynecologist had to " write-off " the
>balance. In other words he did a difficult surgery but was not paid
>adequately!! I know that the same thing happened for both the hospital
>and the anesthesiologist - both had to be satisfied with what Medicare
>paid them. Neither the gynecologist, the hospital, nor the
>anesthesiologist could bill me for the unpaid balance!!!
>
>Another thing I learned was that there are certain hospitals in the
>United States which WILL NOT ACCEPT MEDICARE PATIENTS!!! That's right!!!
>The low payments, which Medicare reimburses doctors and hospitals with,
>is intended as Medicare's way of protecting seniors from excessive
>medical charges...which , unfortunately, prevents seniors from seeking
>the very best professional care.
>
>So I can understand why many doctors do not do diagnostic
>procedures...but rather look and wait for another better-paying surgical
>procedure to arise.....SUCH AS HYSTERECTOMIES...and many hysterectomies
>are DONE FOR THE WRONG REASON!!
>
>I read an interesting book by the name of " Women and Doctors "...which
>was written by a male gynecologist. What I found really surprising was
>that this male gynecologist was actually advising women to seek medical
>care from female gynecologists...rather than from male gynecologists.
>His reasoning is that female gynecologists understand women and their
>medical problems far better than male gynecologists do. When in the
>care of a female gynecologist, women can avoid certain male
>gynecologists who may "prey" on women by suggesting surgical procedures,
>such as hysterectomies, when a hysterectomy is not warranted at all.
>Don't let this happen to you!! Learn as much as you can a medical
>problem, which you may have; and consider seeking second opinions before
>undergoing the knife!!
>
>[] NOW, CONTINUE ON WITH BEV's MESSAGE:
>
>" Now, by asking for the $3000 up front in Scranton, this assures that
>in the event the insurance company doesn't pay for a lengthy
>adhesiolysis procedure if your very involved with adhesions and the
>surgery takes 4 - 10 hours, and trust me, they will not pay for
>that...then DR. Redan, or Dr. Reich have at least been compensated for
>their time, skill and expertise in lysing adhesions. If your surgery is
>within a " normal " range of time, and all the pre-payment is not
>utilized, you get all or some of it back. I had a 5 hour surgery, and
>was refunded a decent portion of it after my surgery! The $400
>consultation fee is just what you pay for the experienced specialist if
>you want them. A person wouldn't think twice if you were talking open
>heart surgery...you would go to and pay for the best Dr. in the world
>if it meant your life, right...well this is your life too, it is just
>that it is under-rated as a problem unless you're the victim of ARD
>(Adhesion-Related Disease)!! Money spent is scary, sure, but money is
>nothing without the life to spend it on!"