Now Hear This Hector.... I Have a Life Too!

Sometimes a visit to the doctor's office can be very frustrating. Today was one of those days.

Scott Lunin recommended that I get a "baseline" hearing exam before I begin chemo next week. Florida Cancer Specialists made the arrangements for me to see an ear, nose and throat specialist, Dr Hector Hernandez, who Scott recommended.

I was busy with client meetings this week because I am headed to Miami on Thursday and Friday. Anyway, I was trying to squeeze appointments in before I leave for Miami. I had a 1 PM and a 2 PM appointment and I was suppose to be at Dr Hernandez's office at 3:30 PM. I had to cut short my second appointment because I was running late. (Luckily, Ryan took over and closed the business for me.) I left the office at 3:20PM and called ahead to let Dr. Hernandez know I would be about 10 minutes late.

When I got to the office, the receptionist asked me to fill in an arrival slip and then asked to see my ID and insurance card. I gave her both and the first thing she said to me was "We don't accept Cigna Open Access; we only take Cigna PPO." (She might as well be speaking Greek to me.) So then I said, " What does that mean?" And she repeated...we only take Cigna PPO. So then I said, "Well, I don't understand. What does that mean?" She then started to explain that they had been PPO with Cigna but they were changing to Open Access and would be OK after February 15th. There are "in network" and "out of network" health care providers and they (Hernandez) are currently out of network. So then I said, "So, what does THAT mean." She said that I would have to pay myself for this visit. (Finally I understood!) So, of course, I said, what is it going to cost? And she said...well what are you here for?

Are you feeling my pain yet?


So I said, "I am here to have my hearing checked. Didn't Florida Cancer Specialists tell you why I am being referred to you? I was suppose to get a baseline hearing test." Then she said, well, the doctor appointment costs $160 and sometimes he does procedures that could be another $200. Then I said, "Well, I don't think I am having any procedure done. I am simply here cause Scott Lunin said I should have an audio test. I would have thought they would send me to a doctor that takes my insurance."


So then she wanted to know if I would like to go to a different doctor. I said, first I don't know where else I would go, and second, I need to have the baseline test established before chemo begins next Friday. (I could have fixed this anytime in the last two weeks had I known they don't take my insurance.) She then explained that I could submit the doctor bill myself for reimbursement. I said fine, I will pay for the visit myself (thinking I would be reimbursed by Cigna). (I bet you can already guess how this story ends!)


Anyway, the receptionist gave me a bunch of forms to fill out and I sat down in the waiting room at 3:45 to wait. Finally at 4:30 (one hour after my scheduled appointment) I was called. (Why, I wondered to myself, was I rushing to make this appointment and calling ahead to say I would be 10 minutes late? Doctors don't care how long they keep YOU waiting. When was the last time a doctor called to say, "take your time, we're running behind here." The only time a doctor calls is to remind you of your next appointment.)


After I was finally called I followed the nurse into an exam room and the first question SHE asks me is "what are you here for? Are you suffering from hearing loss?" At that point (as patiently as I could) I explained that I was a cancer patient, sent by Dr. Lunin to see Dr Hernandez to establish a baseline audio test prior to chemo. I suggested that she call Dr. Lunin and ask him why he made the referral and what he wants done. The nurse did exactly that and had Florida Cancer send over the pertinent information. Dr Hernandez walked in the door of the exam room at around 5 PM.


While I was waiting in the exam room I read about Dr Hernandez's education -- John Hopkins, University of Pennsylvania medical education. Seems like a well educated doctor...


Anyway, when I finally met Hernandez I began to quiz him about why testing was needed. He explained that the chemo I am having can frequently lead to hearing loss. My next question was what happens if hearing loss is detected? He replied that we would then have to decide whether we want to continue the treatment or not. I wanted to know whether the treatments, if stopped, could be stopped in time to prevent hearing loss. Or would it be more like trying to stop a ship in the water. Would chemo continue to affect my hearing even if the treatments were stopped? (Apparently the toxic impact on your hearing does not stop even if you stop treatments.)


I asked which drug caused hearing loss and the answer was the Cisplatin. I asked why Cisplatin causes hearing loss and all I could understand was that the fibers in your ears that are the sound receptors are affected, but no one knows why. I asked, why I did not have baseline testing done prior to beginning the first round of chemo? He could not answer for Dr. Lunin, but he believes that ususally the baseline testing is done once the cancer has come under some control. Since lung cancer is a life threatening disease, the first priority is to get it under control with the available treatments. When we treat the cancer as a chronic ailment, it becomes more important to monitor for potential side effects, such as hearing loss. That made sense to me.


Dr Hernandez then stuck some electronic handheld device in my ears to make a measurement of my "receptors." I thought this was part of the exam. It appears that my left ear is fine but my right ear is being affected by the chemo I have had to date. Dr Hernandez recommended that I come back for a full audio test (which is what I thought I was there for to begin with!). He would want to monitor me carefully during the upcoming treatment. I have no problem with any of that. The purpose of monitoring would be to detect hearing trouble.


That's when I brought up the insurance issue. I told Dr Hernandez that I did not understand why but he could not accept my insurance. But given the time constraints, I wanted to know what other doctors in town he would recommend. He was somewhat incensed that I would ask him about insurance and said "The ladies up front handle that. If you need to go to another Doctor, do that. I am just telling you, clinically, that you should have a hearing test and be carefully monitored." It was like, how dare you ask me about money or using another doctor!


At this point he handed me off to the nurse, who guided me to the check out window. The lady at the check-out window asked if I could come in on Thursday or Friday. Of course, I said I can not (I am going to be in Miami). She then said to me "But the Doctor wants to see you this week." So I told her I can not make it this week and I will have to check MY schedule to see when I can come back. I was then admonished to call tomorrow to make an appointment before being handed a bill for $360. Apparently it was $160 to see Hernandez and $200 to stick the handheld device in my ear. (That must have been "the procedure" the check-in girl was talking about! Holy mackrel!!)


When I got home tonight (I came straight from Hernandez's office -- no use going back to MY office) the first thing I did was call Cigna to find out what I needed to do to make a claim. Apparently, I have a $600 deductible for seeing an "out of network" specialist without pre-authorization. So NONE of the $360 will be reinbursed to me -- it would be applied toward my deductible. In fact, if I have to go to Hernandez again (until he is "in network") I will be out of pocket. On the other hand, had Florida Cancer Specialists handled this properly, they could have obtained authorization from Cigna for me to go to an "out of network" specialist and then I would have been reimbursed. Geez.

I hate being stuck for a bill like this when my insurance would have paid; that's bad enough. Hernandez kept me waiting an hour and a half; could not accept my insurance, did not conduct the baseline test today that I went there to have done and charged me $360 for the privledge. The worst part is that they (the doctors and nurses) act as though my life should conform to their schedule: that I have nothing better to do with my time than to wait around for them to see me.


If you can't tell by my tone, I was fairly irked by the whole experience. I have half a mind to send Hernandez a bill for MY time, which is very very valuable to me -- esspecially now!