[tweetmeme source=”Healthmessaging” only_single=false]Let me start by saying I really like MD Anderson Cancer Center. There is a lot to like. Take their tag line for example, “making cancer history.” If anyone finds a cure for this cancer or that cancer…MD Anderson will have a hand in it I am sure. Hospitals could also learn a thing or two about the meaning of comprehensive care, clinical integration, and customer service from MD Anderson is well.
I have another reason why I like MD Anderson so well.
They saved my wife’s life. You see she was diagnosed back in November of 2004 with Stage 4 non-small cell lung cancer (NSCLC). As anyone familiar with lung care knows, lung cancer is a very tough adversary.
It’s an even tougher adversary when your insurance company insists that your local community hospital and oncologists are “just as good” as MD Anderson’s in terms of quality and outcomes.
You guessed it. In 2004, my wife and I had to fight long and hard to get our insurance carrier to authorize my wife care at MD Anderson…an out of network provider. I am happy to say we won that fight back in 2004 and again just last week when my wife’s employer’s new insurance carrier refused to authorize her continued care at MD Anderson. You see her new carrier wanted to rehash the whole medical necessity thing all over again.
Now you would think that a world class organization like MD Anderson would do everything possible to help prospective patients deal with these kinds of insurance issues. After all, they seem to do everything for you once care is authorized. But you would be wrong.
The business office staff at MD Anderson did little to help us get “authorization” in 2004 or 2011. This time, we got the proverbial run around from every member of the business office staff we talked to. Most recently I had 3 different staff members contact my wife’s carrier. Each person failed to get authorization giving us three different explanations. One person even told me that my wife could not be authorized for a PET-CT exam because she was disease free at her last visit. Evidently she had to have active disease before she could qualify for preventive screening exam. I even asked the business office coordinator if she reminded the insurance carrier that MD Anderson was the #1 Cancer Hospital in the U.S. I don’t think she thought to mention it.
Not to worry. In 2011, as in 2004, I, with the help of my wife’s clinicians, was able to demonstrate the “medical necessity” of her being treated at MD Anderson. No thanks to the hospitals business service however.
What’s the Point?
The point is that the wonderful brand experience my wife associate with the clinical side of MD Anderson does not extend to MD Anderson’s business services, e.g., pre-authorization, etc. In fact I will go so far as to say that I do not trust anything that comes out of the mouths of that department.
How could such world class organization make such a first class blunder with something as important as obtaining helping patients obtain “authorization for care?” More importantly, how many cancer patients get sub-optimal treatment because they aren’t as adept as I am at navigating my way through the health care system?
I honestly don’t know. But if MD Anderson wants to hire me to come in and help them fix the problem my phone number and email are here below.
Business: 408-448-1537 (PST)
swilkins@smarthealthmessaging.com
Mind The Gap 
Great message. Definitely will be inspiring for others that aren’t getting the right answer to keep trying to get the care they deserve.
While I’ve seen many cases where healthcare providers do bend over backwards to get you the care and the coverage you need, there are certainly exceptions like this one you mention. This is often due to many organizations not investing in these areas of the business since “the doctors” are the core of the business right?
You are blaming MD Anderson for problems that are 100% the creation of the insurance companies.
I find myself frequently in the position of working myself to a pulp and failing to get a pre-auth for a procedure, and, yes, the patient blames me 100%. That’s a fact of modern medicine. The insurers have no interest in treating both patients and providers as anything but problems. The only one who MAY have any influence with them is insuree’s employer.
Southern Doc,
Help me understand how I, the patient, could get “pre-authorized” for care when the hospital’s own business “experts” could not do it. In fact the insurance company was much more helpful than the hospital. Go figure…
I didn’t say that the patient would be any more successful. A fired up HR manager may be effective dealing with an insurer if they threaten to take their business elsewhere.
My point is that the patient and the provider are equally powerless in dealing with insurers. My guess is that the “three different explantions” may have been what the MD Anderson staff were told at different times by the insurer. I have honestly been given 12 reasons why a certain prescription was not covered. I have had patients accuse me of being “unhelpful” when I have literally expended hours and hours of my time trying unsuccessfully to get a pre-auth.
It stinks, doesn’t it?
Southern Doc,
Thanks for your insights on the subject. I know that has to take up a lot of time from you and your staff. Maybe we ought to network all pre auth staff via social networking to share the secrets of getting authorized by Plan and condition.
“Secret” is the operative word here!
I just wish patients would understand that providers are given no more clues as to how to work the system than patients are. And, unlike Medicare, private insurers can change policies, procedures, even phone numbers every 30 minutes without informing anyone.
An “out of network” provider has absolutely no clout in dealing with an insurer. They have no access to policies, formularies, necessary forms, phone numbers, etc.
The patient rep at the insurer may be very friendly on the phone with the patient, but you can be sure that behind the scenes they are working overtime to avoid paying the provider anything. They have a direct financial interest in not paying out of network charges.
If you (or more likely, your employer) choose an insurance plan with a network, and you elect to go out of network, the brunt of the work involving payment falls on the patient. It’s terrible that this has to be dealt with at the same time as dealing with a serious illness as in your case, but that’s the system patients and physicians find themselves in.
I too have experienced undue stress and frustration in dealing with MD Anderson Business Services . I live on the Mississippi Gulf Coast and was diagnosed with melanoma in summer of 2008.
When my dermatologist told me I had melanoma, we discussed treatment options (which doctor and institution would be best), and I decided to go to MD Anderson. My dermatologist helped me get an appointment, at which time I contacted my insurance, where I was told that MDA was out-of-network, meaning my insurance would pay 60% as opposed to 80% for in-network providers. I immediately called MD Anderson and told them I would have to cancel my appointment and seek care locally, as I could not afford the difference going out of network would make. I began making arrangements locally until I received a call at work the next day from a representative of MDA telling me they had arranged to have me billed through the “multi-plan network”, which meant my insurance would pay 80%. I also received a follow up fax confirming the same information regarding my insurance. The fax clearly stated that it would be “in- network” and that insurance would pay 80%. I gave them permission to reschedule an appointment to begin treatment at MD Anderson.
Following 2 surgeries. the bills started to come in. I was surprised that insurance had payed as I was assured it would on hospital services, but had not done so with physicians, leaving a balance of almost $13,000. When I contacted MDA, I was told that I needed to contact my insurance in order to try to get additional payment. I was told by Blue Cross that their payment for hospital care was through the multi plan network but that they did not pay through the multi plan network on physicians and that MDA was aware of that. I was further told by Blue Cross that, as I had met my out-of-pocket deductable of $2,000, they actually paid 100% of all allowable charges, even to physicians. This means that if the contract had been in network as MDA assured me it would be, I would actually owe nothing.
I have contacted eveyone imaginable at MD Anderson for the last 3 yrs. in an attempt to settle this. They continue to say only that I’m responsible for any charges not covered by insurance. My attorney has contacted MDA through a detailed letter of complaint disputing the debt and accusing them of false inducement. The letter was never acknowledged, and MD Anderson has never indicated that they bear any responsibility for my decision to seek treatment there based on what can best be termed medical “bait and switch”.
I also like MD Anderson, am grateful for the top-notch treatment I received there, and am impressed with their overall approach to patient care; however, I have never experienced failuire to accept responsibility on such a level. My last contact with MDA was in a call from them today, where after explaining the situation fully to the Business Services rep., I was told that she, another business services rep. and a supervisor would call me back on a conference call. I have yet to hear anything further from them. I will continue my fight to resolve this debt equitably, but obviously I will do so without assistance from MD Anderson Business Services.
I received a follow-up call from Business Services at MDA and was told that since the account was so old, they would be reviewing it to determine what kind of discount I might be given or whether the balance might even be written off entirely. This was the only optimistic response in the @ 3 yrs. I have been dealing with the account balance. Today, having heard nothing and after receiving a notice from a collection agency for $92.60 I owed MDA (no idea where the amount came from), I called and left a message with the woman I had dealt with in Business Services. When she returned my call, she informed me that they had reviewed my account and that since the hospital had in fact been paid at 80%, I would be responsible for the balance owed the physicians (@ $13,000) . The logic of their decision illudes me, but I will now turn the matter over to attorneys, as the stress it is causing me is damaging to my health. I have always been careful to “get everything in writing”; I now find that even that sometimes makes no difference.
Saturday, June 18, 2011, I received a statement from MDA dated June 13, 2011 stating that I have an outstanding balance of $12, 717.29 which must be paid within twenty-one days from the date of the notice in order to prevent referral of the balance to an outside agency for collection.
In the past 3 yrs, I have talked with MD Anderson dozens of time by phone and in person about the matter with no answer other than that I am responsible for the balance. They have never apologized for having provided incorrect information or accepted any responsibility for the discrepancy, and I have never received a written response regarding my disputing the balance. So much for professionalism and integrity in the financial office of one of the nation’s leading medical service providers.