Gaming the System

Good morning.

I’m happy to say that today’s post will be about more than just travel experiences and whatnot.  However, before I get into the story I want to relay, I must share two quick tidbits:

Lining up for early boarding.

Lining up for early boarding.

When flying home via JFK two weeks ago, the wheelchair attendants did something I’ve never seen before – they actually lined up all the wheelchair passengers and escorted us right to the plane well before anyone else boarded.

Here we are, lined up like the start of a Formula One race.  I’m sorry to say I did not get Pole Position.

Second, it’s always fun to shop in places where the proprietors enjoy their work.  This past Friday, Tammy and I went out in search of some herring.  We went to a favorite cheese and fish store but, lo, there was no herring in cream on the shelf.  So we asked, and the proprietor said, “If you have 20 minutes, I’ll prepare it for you.”

Yossi invited me to the back to hang out while he made the herring!

Yossi invited me to the back to hang out while he made the herring!

How could we say no? So, here’s Yossi the store owner, preparing some fresh herring in cream just for me. “Do me a favor,” he said.  “Next time, call me Thursday night and I’ll make it for you…”

Here’s the funny thing: Yossi’s never tasted herring in cream.  He’s been making the recipe for years, but having grown up in a Sephardi home, he just doesn’t have the taste for it.

Anyway, on to the story I want to share.

Last Thursday was my oncologist appointment to check in following her discussions with the liver specialist and the surgeon regarding what to do with me in terms of surgery.  The surgeon wants to operate but, in order to make a final determination (and to get me onto the schedule) I’d have to go see him again.  In order to go see him, I’d need to have a CT done in advance so he can see the absolute latest.  And – more good news – since we’re waiting to see when surgery might be, my treatment for this week is cancelled as there needs to be a break from chemo of about six weeks prior to surgery.  And, since treatment is cancelled, I would be able to go to New York this week for some planned meetings and events.

But therein lies the challenge.  How to secure an appointment with the surgeon, and appointment for the CT and authorization for both from the HMO all within enough time for me to be able to get to New York early this week?

Well, thank God we’re not newbies.  We walked right out of the oncologist’s office and Tammy immediately got on the phone with the hospital scheduling office and requested an appointment with the surgeon. “June 18th is the earliest,” she was told.

“That won’t do,” says Tammy.  And, bending the truth just a bit, explained to the representative that I need to see the surgeon immediately as we need to schedule surgery.  And, oh by the way, I have cancer.

“How’s Sunday at 3:15?”

Now we’re getting somewhere, and Tammy plows on: “We also need a CT.  Immediately.”

“I have nothing before your Sunday appointment with the surgeon.  Perhaps you can go to the CT department in person and they can do something for you.”

So, we started our trek through the hospital, found the CT department (This is not the one I usually go to.), and started to explain the whole story to the young lady behind the counter. After much back and forth she says, “I can get in you in right now, but you need to get the authorization from the HMO.”

Not sure what to do, Tammy and I were stumped.  So close, yet so far.  The young lady trying to help got into a conversation with her coworker and the two decided that perhaps I could just pay for CT on the spot and then get reimbursed from the HMO after the fact.

Possible, but not ideal.

Then, an epiphany! The second person behind the desk suggested we go straight to the HMO office in the hospital to see if they can help.

And away we went.

We found the office and spoke to the lovely woman (Berta) behind that desk.  “I’m sorry, I can’t help you.  Your family doctor needs to enter the code.”  She was sweet, and we could tell she wanted to help, she was just clearly overworked and stressed and couldn’t figure it out.

Cue the cancer.

Tammy began to explain to Berta that I need to see the surgeon on Sunday and that we absolutely must get a CT beforehand, and the nice folks upstairs at the CT place are holding a spot for me, and isn’t there something you can do?

“Let me see what I can do.” And away Berta went to confer with her supervisor. She came back willing to help, except in order to do anything she would need the code to enter the request into the system and neither Berta nor her supervisor know the code.  That, we can only get from the primary care physician.

Undaunted, Tammy suggested that when I had my original CT done in October 2011 when all these shenanigans began, I needed an authorization from the HMO and perhaps the elusive code would be attached to that approval and perhaps you’d be kind enough to look back to that approval to see if there is a code there?

Wouldn’t you know it, Berta was able to get the code and enter the request.  All we had to do was wait.  Sitting there with Berta, she started telling us about her sister who has colon cancer, and we bonded even more.  Tammy, in full offensive, politely asked if Berta would be so kind as to help us with the approval for Sunday’s surgeon appointment and, Berta took care of that as she continued to recount her sister’s story with cancer (She’s doing well, six years on.) while blessing me with good health.

The approval came through, we wished each other a Shabbat Shalom and went back upstairs to CT.

Suitably impressed, the young lady behind the desk there sent me straight into the CT prep room where I started the process of drinking the preparatory drinks, had the IV started shortly thereafter and, within a reasonable amount of time, was called in for the CT.

(In the interim, Tammy bough flowers for Berta. Never hurts to have a friend at the HMO…)

People sometimes ask me why I don’t pursue treatment in the United States.  Why would I?  Would a story like this one ever, in a million years, happen in the United States?  Can you imagine that, within the space of six hours, I’d be able to see my oncologist, get an appointment with the surgeon within one business day, get squeezed into the CT roster on the spot, get HMO authorizations for both the surgeon and the CT on the spot, have the CT done and leave with a disc of the CT?

Thank God we have almost three years of dealing with under our belts and that Tammy thought so quickly on her feet.  We’re all set to see the surgeon in a few hours and, later tonight, I’m off to New York.

Whew.

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About Alan

F---ing Cancer since 2011.
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16 Responses to Gaming the System

  1. Mom says:

    Isn’t it great to have your own personal concierge? She really knows how to, as you said, think on her feet. I wonder who she takes after? See you tomorrow.

  2. Cousin el says:

    That story is amazing and so are you and so is Tammy!!!! Hope all goes well with the surgeon today and safe travels tonight.

  3. Lisa says:

    Amazing. Amazing – wes says you should’ve named your wheelchair to improve your winning odds. ;))
    Safe flight & how yum was the herring?

  4. Adam D. Hammerman says:

    Bring herring and Yossi’s phone number !

    How long will you be here?

    Adam D. Hammerman (Sent from my iPhone)

    >

  5. Ari / Wesley Hills says:

    Had you also been wearing a face mask, I think you could also have gotten surgery the same day too! Feel good.

  6. Wendy B. says:

    And therein lies only one of the reasons why we need Israel….and Tammy! You are both wise beyond your years. Tammy, perhaps you should start a business advocating for cancer patients. The irony would be that you’d need to get paid through HMO but it sounds like Berta could make that happen. Safe flying!

  7. u.d. says:

    That wife of yours is something

  8. Ilana says:

    I definitely want Tammy on my side. Anytime. And how is that we don’t see ;you given that you live kind of over the road. And down a bit

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