My waiting game continues...

Silbar
Silbar Member Posts: 163
edited January 2018 in Waiting for Test Results

I just want to share my little journey so far and also have a safe place to vent. I thought that my waiting game was coming to an end when I got my stereotactic biopsy results on Dec.1. It showed peripheral intraductal papilloma with a cluster of micro calcifications. I met with a BS on Dec.11 who recommended an excisional biopsy. Unfortunately I had developed a large hematoma from the biopsy procedure and he said we would have to wait a few weeks for it to resolve before he could do the excision. His words were "It would be a huge mess" if he tried now. Come back in two weeks and we will see how it looks and proceed  from there.  So, OK I can wait a few weeks as it was very uncomfortable at the time anyway and the results so far are B9. His office was closed the last week of Dec because he was moving his practice to another office and won't be available until after the New Year.

Well, now I am stuck with new Obamacare insurance, AmBetter (AB),  (my insurance in 2017 was great) but I have to switch over to what is available in my area. I live north of Atlanta. AB is requiring me to change PCP. I called the new PCP's office 2 weeks ago and they will not even schedule me for an appointment until after my insurance begins. I've never had a doctors office tell me that they cannot even schedule an appt and I can show my new card when I get there. This did not instill any confidence but I have to jump through their hoops. Hopefully they will be able to get me an appointment soon. Also, AB will not cover any new visits with the BS until this new PCP sees me and then submits a request for authorization for me to see the BS. They said that takes 30 days. What a bunch of poop!! Once I get their authorization then I can schedule an appt with the BS. After I see him, he will then need to submit a request for authorization to get the excisional biopsy and that will take another 30 days! 

So, it looks like I am going to have a 2 month wait until I can get the excision done, that is if they authorize it. I have decided to call the BS on Tuesday to go ahead and make my follow up appt just to get the ball rolling. Most likely I will see him before AB makes their decision and  I will have to just pay the full price for his visit for now. That's OK. This way I won't have to wait an extra 2-3 weeks to be able to get an appt. He is a very popular BS in my area and has done a fellowship in oncoplasty.

My hope is that if I see him now he will say the hematoma has resolved enough to be able to proceed. Then whenever AB authorizes me to be able to see him, I will just call his office and ask him to go ahead and submit the authorization for the excision. Maybe that will shave off some of the waiting time. I am thankful that I do have some form of insurance and if needed I can pay the full cost of the excision if AB denies it. One more year of this poop insurance and I will be able to get Medicare with an Advantage plan. I will be 64 in Feb.

Just for info, I have a strong family history of BC and I have been taking Raloxifen for several years due to osteoporosis and menopause.

In the meantime, I have found this site to be a great place to share and learn from each other. For those who are waiting for answers and for those who are going through treatments, my prayers are with all of you. Thank you for sharing your journeys as they are very helpful to me and others. 

Comments

  • Georgia1
    Georgia1 Member Posts: 1,321
    edited January 2018

    Well, that is a "poopy" way to start the new year. Despite the annoyance of the insurance it sounds like you are moving forward with a solid plan so yay you. Best wishes and stay proactive!

  • Silbar
    Silbar Member Posts: 163
    edited January 2018

    Thanks Georgia, I always feel better when I can be in control even if it is only a little bit. I hope the BS's new office will be open tomorrow so I can set up an appt with him. I also need to request a copy of my record from the last visit with him. I will need to provide this and copies of all my tests & biopsy (which I already have) to the new PCP whenever they get me in to see her. This way she will have all the documentation she needs to send her request to the  insurance for why I need the authorization to go back to the BS. I hope I can get the authorizations by the end of Feb...it will be a great birthday gift! 

    I guess when life gives you "poop" you make "fertilizer".

  • Silbar
    Silbar Member Posts: 163
    edited January 2018

    I was able to schedule a follow up appt with my BS for Jan.10. The office also emailed me a copy of the BS's dictation from my last visit. I need this to give to my new PCP. I am hoping that tomorrow I will be able to get an appt with my new PCP before then so that she can submit a request for authorization from the insurance so that I can go back to the BS.  If the authorization is not done by the 10th then I will have to reschedule again. I was planning on paying out of pocket just to get the ball rolling but the BS's office said they couldn't do that if I had insurance.

    I'm trying so hard to remain calm while I wait but it is difficult. I just want to get the excisional bx done and move forward.

  • Sahicks
    Sahicks Member Posts: 21
    edited January 2018

    Silbar how totally frustrating fetting caught in the insurance game there should be emergency situations where all the hoops can be dismissed I am sorry you are going through this

  • Silbar
    Silbar Member Posts: 163
    edited January 2018

    Thank youfor your kind words.

  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited January 2018

    Ugh Silbar! How frustrating. Your new insurance situation doesn't seem very customer friendly. At least you're on top of things and trying to push things along. Sometimes, that's all we can do. ((Hugs))

  • Silbar
    Silbar Member Posts: 163
    edited January 2018

    Thanks Elaine. Yes, state run insurance does not move as fast as private insurance does. My situation is nowhere as serious as many of those who are here. There are others that need to get in more urgently than I am so I have to keep all things in perspective.

    I thank everyone for the knowledge and support I get from this site.

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