Has anyone else dealt with a neurosurgeon that refused to accept an AVM specialist's opinion, or two opinions? Our in-network provider is refusing to refer/approve our out-of-network request for surgery. I thought it was insurance, but it turns out the Chair himself doesn't think the surgery is "medically necessary" and that he can do the procedure himself if we really want him to. This neurosurgeon hasn't done an AVM craniotomy in 20 years and has no practical experience with this condition. I'm not naming names publicly to protect this site, so please PM me if you want to discuss specific doctors.
So how do you deal with someone's God complex? We have an appointment with him tomorrow and I was wondering if I could do an audio recording of our meeting. Anyone else out there deal with such road blocks?
Leeka, While I don't know what type of health insurance you have, I would call them immediately and explain the situation. I personally would not want that neurosurgeon to do my craniotomy with very little or no experience.
Please keep us informed. Wish you the best.
I've already informed the health insurance and they refuse to get involved and overrule him. I've filed appeals, left messages, etc. to no avail. I have a complaint filed with the Dept. of Managed Health Care and they are in the process of an expedited Independent Medical Review on the medical necessity question and they are doing a separate peer review to determine if the surgeon is qualified given the need for an AVM specialist. Unfortunately, the results of these reviews will not come in time to have the scheduled surgery next week. If I can't convince him tomorrow morning that he's wrong on all fronts, then we have to postpone. The only way around this man is to change medical groups to one that is in-network to where we want the surgery, but that will delay the surgery for at least a month. I had hoped that after 8 months of daily migraines, my husband would finally have some relief. He had a partial complex seizure last week and I was finally able to figure out that his "episodes" were seizures thanks to research I did on this site.
And this doctor has not returned calls from the surgeon who wants to do the surgery. And he has refused a peer to peer review. Completely stonewalling. I just don't understand why he is refusing to cooperate or consider the wishes of the patient.
I am speechless and that never happens. However, I would not want somone operating on my brain that does not have a lot of experience in AVMs. It might be worth delaying the surgery. Also, if this doctor will not work with you…I would not trust him.
Time for a lawyer, Leeka, in my opinion. You cannot let your health be held hostage to a doc who may have dementia or impaired judgment. Patients should always have a choice who to see; the inflexibility here is cause for grave concern. You can also consider filing a complaint against the insurance company.
Delay the surgery and get an attorney! Delay is most likely not as bad as incompetence and such arrogance. Best wishes!
After a very stressful meeting, we were able to come to a meeting of the minds. We are proceeding with the out-of-network provider and will change medical groups after the procedure so that we can continue to manage our care in-network going forward.
The original in-network neurosurgeon wasn't clear in his notes that he wasn't comfortable doing the surgery, he simply said he didn't recommend it, and the chair was trying to send us back to him to keep the costs in-network. Once we cleared that up, there were no more arguments.
We had to postpone the surgery by two weeks because the paperwork couldn't be done in time, and they had to rebook the angio OR, but we're only looking ahead now.
I was wondering how it turned out! Thanks for the update!