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When A World-Class Medical Institution Saves You Yet Fails You

Let me start by saying I really like MD Anderson Cancer Center. There is a lot to like. Take their tag line for example: “Making care history.” If anyone finds a cure for this cancer or that cancer, MD Anderson will have a hand in it, I’m sure. Hospitals could also learn a thing or two about the meaning of comprehensive care, clinical integration, and customer service from MD Anderson is well.

I have another reason why I like MD Anderson so well: They saved my wife’s life. You see, she was diagnosed back in November of 2004 with stage four non-small cell lung cancer (NSCLC). As anyone familiar with lung care knows, lung cancer is a very tough adversary. It’s an even tougher adversary when your insurance company insists that your local community hospital and oncologists are “just as good” as MD Anderson’s in terms of quality and outcomes.

You guessed it. In 2004, my wife and I had to fight long and hard to get our insurance carrier to authorize my wife care at MD Anderson, an out of network provider. I’m happy to say we won that fight back in 2004 and again just last week when my wife’s employer’s new insurance carrier refused to authorize her continued care at MD Anderson. You see, her new carrier wanted to rehash the whole medical necessity thing all over again.

Now you would think that a world-class organization like MD Anderson would do everything possible to help prospective patients deal with these kinds of insurance issues. After all, they seem to do everything for you once care is authorized. But you would be wrong.

The business office staff at MD Anderson did little to help us get “authorization” in 2004 or 2011. This time, we got the proverbial run around from every member of the business office staff we talked to. Most recently I had three different staff members contact my wife’s carrier. Each person failed to get authorization giving us three different explanations. One person even told me that my wife could not be authorized for a PET-CT exam because she was disease-free at her last visit. Evidently she had to have active disease before she could qualify for preventive screening exam. I even asked the business office coordinator if she reminded the insurance carrier that MD Anderson was the #1 cancer hospital in the U.S. I don’t think she thought to mention it.

Not to worry. In 2011, as in 2004, I, with the help of my wife’s clinicians, was able to demonstrate the “medical necessity” of her being treated at MD Anderson. No thanks to the hospitals business service, however.

What’s the point?

The point is that the wonderful brand experience my wife associate with the clinical side of MD Anderson does not extend to MD Anderson’s business services (e.g., pre-authorization, etc.) In fact, I will go so far as to say that I do not trust anything that comes out of the mouths of that department.

How could such world-class organization make such a first class blunder with something as important as obtaining helping patients obtain “authorization for care?” More importantly, how many cancer patients get sub-optimal treatment because they aren’t as adept as I am at navigating my way through the healthcare system? I honestly don’t know, but if MD Anderson wants to hire me to come in and help them fix the problem, my phone number and email are below.

Business phone: 408-448-1537 (PST)
Email: swilkins@smarthealthmessaging.com

*This blog post was originally published at Mind The Gap*


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