Today was a great day! Medicare reversed a denial and is requiring my Medicare Advantage insurer to cover my consultation with Dr. Eric Liu who is a renowned specialist in Neuroendocrine Cancer and who is now in Denver.
The background is this: At my request, my oncologist wrote a referral to Dr. Liu. She warned me the the Medicare Advantage HMO would probably not approve it. She was right. They denied the referral saying that the HMO had the knowlege and facilities to treat Carcinoid Cancer within their network.
They have an appeal process. I wrote an appeal and included the NANETS 2013 Guidelines for the Diagnosis and Management of Neuroendocrine Tumors and the NANETS 2010 Guidelines. These guidelines were unknown to the oncology dept. where I am treated until I showed them to the doctors.
The HMO denied the appeal, but, because this insurance is a Medicare Advantage plan, Medicare requires that they get to review the appeal and denial. After review, Medicare reversed the denial! The health insurance is required to pay for my consultation with Dr. Liu. Socialized medicine worked for me!
I will certainly blog about my visit with Dr. Liu after it happens next week.
In other news, I am going fishing again tomorrow for three nights. We are not camping this time. We are renting a house in Salida, CO on the Arkansas River. The weather in Colorado has been amazing and I am looking forward to good weather and good fishing.