Last Friday I mentioned that my blog post that day would be abbreviated due to a medical appointment. I duly attended it, and it accomplished what I wanted. I asked about alternative neurosurgical practices, since I'm not happy with the one I've been using, and the doctor referred me to another neurosurgeon in Dallas for further investigation. (It seems the problem is to decide precisely what surgery I need: to fuse two or three more vertebrae in addition to the existing pair, or to remove the latter and encase my entire lumbar spine in a sort of metal cage to stabilize the whole area. There appears to be serious disagreement over which approach would work best, so I've asked for a second opinion from a more professional professional, if you know what I mean.)
So far, so good . . . but then I called the new doctor's office to set up the appointment. The conversation went something like this.
Me: I've been referred to Dr. X for further investigation of my spine injury. My medical insurance is XYZ, and you should have been sent my medical history, copies of X-rays and myelograms, and all that stuff.
Doctor's nurse: Let me check . . . Yes, we have those. You'll have to get another myelogram, though, because the previous one was done more than six months ago. Dr. X won't see you until the new results are available.
Me: Er . . . this is a problem. A myelogram is a very expensive and complex procedure. I can't just ask for it as a private patient: I have to be referred for it by a doctor. However, if Dr. X won't see me, he can't issue the referral; and my local general practitioner certainly can't do so, because it's a specialist procedure. I can't ask for a referral from my previous neurosurgeons, because I'm moving on from them. What now?
Doctor's nurse: I'm afraid that's Dr. X's protocol. He won't see you without an updated myelogram.
Me: Well, his protocol has just run headlong into medical bureaucrats, and I'm pretty sure they're going to win. You're asking me to do the impossible.
Doctor's nurse: I'm sorry, but my hands are tied. You're going to have to find some other way to get that myelogram.
Me: Hangs up, bites tongue, bangs head against brick wall, etc.
I checked with my general practitioner, and sure enough, they can't refer me for a myelogram because it's a specialist procedure, outside their area of competence. The neurosurgery practice that ordered the previous myelogram has no good reason to order another one. After all, I'm going to see one of their competitors for a second opinion, so they'll expect the new doctor to prescribe whatever tests he thinks are necessary. They're not going to do it for him.
"Laugh!", they said. "Things could be worse!" So I did. And they were.
Oh, well. This, too, shall pass . . . I just need the administrative equivalent of an enema for the bureaucrats, to make sure it does!
Peter
12 comments:
I'm dealing with my own issues with insurance. We changed carriers beginning in December 2025 and the new company refuses to honor the prescription the former had. I have been without that specific medication now for 5 months, using some of my emergency stock of it spacing it with the old former prescription of medications I had before. I just received permission and acceptance for paying for the new medication prescribed by my doctor. And only took 5 months to get this done.
I thought I was the one paying ? Insurance did not mention the conditions it will accept allowing to go forward before I purchased. I am sad. And angry.
Why won't your primary care doc give you a neuro referral for a second opinion?
We call that Catch 22.
Under the US system, whoever orders the test is responsible for treating whatever abnormal condition is found. So nobody orders tests until you are under their care. Sounds like this specialist doesn't want to treat you.
Just curious....how does Dr. X earn money if he won't see patients? Perhps he's one of those concierge doctors I've been hearing about?
It would seem to me that Dr. X could refer the myelogram as he is the one who is insisting it be done. ???
AFAIK, it's illegal for a doctor to prescribe for a patient if he's never seen or consulted with that patient, even if only by telephone. I could be wrong, but that's how I understand the system.
I'll deal with the pain before I'll deal with the Drs anymore, at least I can cuss the pain the wife won't let me cuss the Drs.
Peter, it seems like you have found the perfect demonstration referred to as the Catch-22 in the same named book.
hmm.. I would try again and ask to speak to dr.. probably wont work. Then just tell them that their policy is unacceptable very politely and that if you can't see them because they won't send you for test that you will leave very negative review about this situation as it is literally their responsibility to send you for tests they want as you don't have a doctor that has the authority under insurance to send you for that test. Tell them you would be glad to get their advice on how you can get a your insurance to cover this procedure seeing as you don't have a doctor right now that can ask for it other than them if they take you on.
Sigh... this is rough. you ask something reasonable and they respond with unreasonable.
My mom had a myelogram decades ago and it must have been inspired by medieval torture practices.
FWIW - whenever you get to the point, go with the metal option. a family member has scoliosis and is on there 2nd revision (25 years later) and there have been no problems with the rebuilt back.
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