If you have had any problems in accessing medical treatment because of Medicare/Medicaid, HCFA, or SSA ......

From: Helen Dynda (olddad66@runestone.net)
Thu Mar 8 15:52:48 2001

I have been an active volunteer for the International Adhesions Society since its first day on the Internet in April 1999. It has been brought to my attention that there is a group who are going to be doing what they can to promote patient access to medical treatment and medical technology, etc.

This group would like to be able to show actual case histories of how some patients have been told that they have been or are being denied medical treatment by Medicare/Medicaid, Health Care Financing Administration (HCFA) or the Social Security Administration ( SSA ).

If this has happened to you, here is your chance to share your disheartening experience as a result of being denied your right to receive necessary medical care!! Please take a few minutes to share your experience and how it affected you. How soon are these case histories needed? A week from today, I have been told.

Please send your Case History to: Helen Dynda at: olddad66@runestone.net ... before March 15, 2001.

* MY EXPERIENCE WITH MEDICARE: Because of Medicare rules and regulations, I was unable to have my adhesion surgery at the Adhesions Unit at Scranton, PA. Here is what happened:

- - - - - - -

I thought you might be interested in knowing how/why I decided to have my surgery at Duisburg, Germany with Dr. Matthias Korell as my surgeon. From the extensive research I have done on adhesions-related disorder ( ARD ), I learned that the following three surgeons are the BEST QUALIFIED SURGEONS for adhesiolysis procedures: Dr. Harry Reich, Dr. Jay Redan, and Dr. Matthias Korell. These three laparoscopic surgeons are the best adhesions specialists in the world!!

I had high hopes that I would be able to have my adhesiolysis procedure done by Dr. Harry Reich and Dr. Jay Redan at the Community Memorial Center ( CMC ) at Scranton, PA. As Bev suggested, I sent my surgical and pathological reports ( I am so thankful that I only had 3 surgeries in 30+ years! ) and the video from my August 01, 1997 diagnostic laparoscopy to her; and then she reviewed them before sending the reports and video to Drs. Reich and Redan.

Then Dr. Redan reviewed my surgical and pathological reports and viewed the video. He then notified me by email that he felt that my adhesiolysis procedure would be fairly easy for he and Dr. Reich to do...in comparison to other adhesiolysis procedures, which they have done. So, I had passed that hurdle.

My next step was to arrange for an appointment. It was at that point where a problem presented itself!!!! When I tried to arrange for an appointment, I learned that -- because I was a Medicare patient -- I COULD NOT have my surgery done at Scranton!!!!

I learned that Dr. Reich and Dr. Redan refuse to accept Medicare's method of payment for adhesiolysis procedures ... and rightly so!! Adhesiolysis procedures are reimbursed by Medicare to surgeons at one standard fee...without any consideration given to the length of time an adhesiolysis procedure can take -- nor any consideration given to the skill and experience of the surgeons!

I offered to self-pay to have Dr. Reich and Dr. Redan as my surgeons...but I was told I COULDN'T do that either!!!! If the hospital would allow Drs Reich and Redan to perform my surgery -- and if I were allowed to self-pay -- the hospital would be fined!!!

I was offered an alternative: I could have Drs. Reich and Redan could perform my surgery at St. Vincent's Hospital in New York City!

Dr. Redan told me that he had to wait until the middle of August before he would know if his hospital privileges at St. Vincent's had been accepted. Dr. Reich was already performing surgeries at St. Vincent's.

I learned that, if I had my surgery at St. Vincents's in New York, Medicare and my supplemental insurance would pay something ( I have no idea how much ) toward the hospital and the anesthesiologist bills; but I would have to self-pay to have Drs. Reich and Redan as my surgeons!!

What I, as a Medicare patient, cannot do in Pennsylvania...I can do in New York? This doesn't make too much sense, does it? I then learned that everything is MUCH more expensive in New York City...with rooms renting from $225 -$300 a day!!! No doubt having surgery in New York City would be MUCH more expensive too. It was then that I decided that I COULD NOT afford to have surgery in New York City!!

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