I went to an Ear Nose & Throat doctor today to get that hearing loss checked out.
First, they did a hearing test on me and confirmed a mild to moderate hearing loss, fairly even across all frequencies. When I talked to the doctor, he said it was reasonable to get an MRI of my head just to rule out any regrowth of the rare head & neck tumors I had 30 years ago.
When the doctor escorted me over to the scheduling desk to set up the MRI, the receptionist said, “Oh, your insurance doesn’t require an “authorization”, and you can go to any imaging center you like.”
I said that’s great and gave her the address of the MRI place in the strip mall near my home. She said she’d fax the imaging order over there today, and if I don’t hear from them by Monday, to call them and schedule the scan.
I wonder if I’d be among the random 33% that get their referrals denied if I had Medicare Advantage?
I had a similar situation when the ultrasound of my heart came back “serious stenosis of the aortic valve.”
Do not pass “GO” do not collect $200.
I immediately phoned a cardiologist at Swedish Hospital, bypassing the weeks-long wait to see my primary care.
I’m about to try the same thing again today since DH’s CT scan showed a 24 mm nodule and the radiologist made a note to get a PET-CT scan. But his primary care (nurse practitioner) that we saw yesterday refused to refer us and instead referred DH to a pulmonologist which could take weeks. I’m furious! (But DH is mellow and wants to follow the steps the NP laid out for him.)
Everything in Medicine is still by fax. I think it’s because they’re worried about a HIPPA violation if an email goes astray.
Also, some may worry about the quality of an MRI performed in a strip mall vs. one done in a 5-star academic medical center. About 25 years ago I read an article in the WSJ about an MRI study where they compared costs/quality of scans performed in various venues. The radiologists who reviewed the scans judged the strip mall scan to be of highest quality, though all met the standards for diagnostic work. The costs ranged from $3,500 for the scan at a major medical center to about $600 at the cheapest place. So you’re wasting your money if you think paying $3,500 gets you the best work.
Shortly after I read the article, my doctor ordered an MRI of my right leg to diagnose some unexplained swelling. They did 2 ultrasounds on the leg that showed nothing wrong.
The doctor was going to send the order to Methodist Hospital in Houston (which likely would have cost something like the $3,500 in the WSJ article), I asked for a hard copy of the imaging order so that I could shop it around. An MRI clinic in a strip mall near my Houston apartment said they’d do it for $1,000, and if I was willing to do it after 10 PM at night, they’d give me a 20% discount to $800. My insurance co-pay was 20% of the cost, so $160 at the strip mall sounded a lot better than $700 at the hospital.
The MRI confirmed that my leg was swollen (which a visual inspection would tell you). Rheumatologist wanted to send me to an Orthopedic specialist and I declined, “I’m not going to pay $400 to have him tell me my leg is swollen”.
Right leg still about 1-1/2" larger circumference at the calf than my left leg today, without explanation or any symptoms.
If I had this problem I would request Doppler ultrasound, not MRI. Looking for a difference in flow pattern comparing one leg with the other. Lymphedema (where lymphatic fluid doesn’t drain properly) often doesn’t cause acute symptoms at first. (Common after surgery for breast cancer.)
They’ve done other tests over the past 25 years, all with negative results. I asked them about lymphedema and they said there’s no evidence of that. As long as I can still walk 40 miles per week on the leg, I figure I’m likely OK.
Probably not what you (or I) think of as sending a FAX. As handy as a fax machine might be every once in a while, it’s probably about as HIPAA compliant as carrier pigeon. Might’ve meant an eFAX, though, I guess.
For communication between providers and facilities, though, electronic health records have made such items of equipment pretty much redundant. I’m reasonably sure that even the most bare bones establishment has to be operating somewhat in the 21st century in this regard else there’d be no way of dealing with third party payers.
Just learned that last week. Had two prescriptions that prescribed PENS to be dispensed. The pharmacy received the prescriptions and they got (a bunch of gibberish) for PENS. Turns out, the e-terminal must be missing the PENS identifier and it can not be fixed/updated. So, the prescriptions were re-issued in ML and came through fine. Which makes me (and now others to) wonder what OTHER “hidden issues” exist in the pharmacy area that could inadvertently harm/kill patients?