Elissa's Battle

Elissa Rose
1952 - 2005

Update for THE BATTLE June 23rd 2005

I went to the hospital on Monday suffering lots of pain. After arriving at the hospital, I received a phone call from the Department of Managed Health Care saying they are upholding the decisions made by HealthNet and Alamitos IPA and are denying my having this wonderful surgeon perform the surgery on me! The reason?

It’s not medically necessary.

Which means “It’s time for you to die!”

There was supposed to be a panel of three doctors on the same level with my surgeon, a “gynecological oncologist.” I was told it would be presented to a board of three doctors with equal experience to my surgeon. It ended being only one surgeon that made the decision and he was not a gynecological oncologist. How dare he decide my life!

My own oncologist still has not called me in 5 weeks…not even to see how I'm feeling or if there's anything he could do to help me. Incredible! So now with this final decision, I am cash only with no medical insurance to cover anything. On my denial letter from the Department of Managed Health Care, they mentioned I can take this up in court and you’d better believe that we will for it’s already in the works. To play God, as I’ve said before, with someone’s life is not right. So I will prove them all wrong and walk into that court room (with my new surgeon beside me) feeling great and proving them all wrong. The undue stress added to my serious health problem is extremely detrimental. How HealthNet HMO and Alamitos IPA can base their decision on the falsehood by saying that although it’s not medically necessary, the enrollee (me) can still choose to have surgery but with someone In Network, for they feel they can still find someone In Network to do this surgery for me. After 6 weeks of waiting, and numerous appeals, they have yet to offer me anyone. In fact, I have not heard from them at all. No suggestions, no help, just silence.

Back to the hospital… because my protein level was so low due to the massive amounts of fluid (ascites) on my abdomen, they scheduled my surgery for next Monday at 8:30 am. To heal properly, one must have protein in their body. All my protein was in the ascites. So as not to add another 7 days to my cash paid hospital stay, my surgeon said he wanted to drain the ascites from my abdomen to make me feel better and to send me home until Sunday, the day before my surgery. They removed many litres but believe there are still a couple litres left. They will take care of the rest during surgery. It was unreal.

What I can tell you is that this surgeon has been sent from above. When he speaks to me, it’s without watching a clock. He is genuine, he is real…sensitive, compassionate and confident. He’s amazing for I have never met someone like him. And that’s what makes it all so easy, to put my life in his hands and know he’s going to take good care of me.

        ~~Elissa

Well most of you know of my battle. How could someone (me) who has worked her entire life to have medical insurance for her family be abandoned so? For anyone who has been keeping up with The Elissa Saga…This is the latest: I need surgery for my recurrent ovarian cancer or I’m going to die. I have not been on any chemo since my oncologist took me off all chemo March 4th because he said it wasn’t working. The medical director at my IPA Group has repeatedly denied anything with my name that has come across his desk. If any of you have HMO insurance, then you know that within that HMO Insurance is a Medical Group with a primary doctor. The HMO Insurance in my case is HealthNet HMO and the medical group is Alamitos IPA. This is where the monsters of my story come into view. I needed a CT/PET scan, Alamitos IPA shot it down. I would appeal it through HealthNet, they shot it down because my oncologist put in for a combination scan instead of the CT Scan alone. A wording game. This shooting down and appeals game went on for weeks. I finally had the CT Scan (since the PET Scan was denied) and the cancer was on my bladder and stomach and my oncologist suggested I go to my original surgeon for surgery. On May 16th I went to see my original surgeon and like a punch in the stomach, he opted not to do my surgery again. He is not very aggressive when it comes to recurrent ovarian cancer, however, he is in the minority since most Gynecological Oncology Surgeons do take out what’s there …buying time. I want more time. I was sent home to die. He did say it was operable but that he opted not to do it since he “in his opinion” didn’t feel it would buy me more time. In his opinion? Who named him God? I was forced to then not accept what I was told and search for other surgeons, other opinions. I went to UCLA and they said “you need a PET Scan!” Well we all know where that went…it was SHOT DOWN…remember? I called all over but couldn’t find another Gynecological Oncology Surgeon who was on HealthNet HMO. There weren’t any others other than my original surgeon’s team. So a friend sends me to a sensational surgeon who says “You need this surgery and I can help you. I have done 500-750 surgeries just like yours! I will do whatever it takes and I will buy you time because it’s morally and ethically the right thing to do.” He even told this to my IPA Group and to HealthNet. Problem is he’s with Blue Shield PPO. HMO vs. PPO…need I say more? All referrals to have him do the surgery were shot down, all appeals shot down and weeks are flying by. This surgeon even says he’ll do it for free and it’s still shot down. So I get the Department of Managed Health Care (DMHC) involved. I wrote to Senator Boxer, Senator Ortiz, First Lady Maria Shriver, Oprah, Ellen Degeneres, Maury and all the TV Stations along with the local newspapers and you know what? NOTHING! Not one response back to me. This is why insurance companies can get away with this, because they are allowed to get away with it. Just when the Department of Managed Health Care is forcing HealthNet to pay for the surgery, my IPA Group Medical Director steps in once again and says "I have a solution now.” Said he found me a surgeon In Network, even personally scheduled an appt for me with this doctor. He then said “You will not be having your surgery with the surgeon you prefer, you can appeal my decision but that could take up to another 30 days.” When I asked who this new surgeon was and he told me, I nearly died. It’s the associate my original surgeon who said he wouldn’t do the surgery... So now they are sending me to his associate? Someone with 18 years less experience... Conflict of Interest. Where will the unbiased opinion be? This surgeon has a small fraction of the surgical experience my original surgeon has and is absolutely dependent him. He’s this surgeon’s boss. Well the consultation went like this: “Elissa, you just won’t accept our bleak outlook on your life. We can’t help you.” Then upon leaving this surgeon says, “Oh by the way, I love your shoes!” So since then, it’s back with the DMHC for an Independent Medical Review. I’m still waiting and waiting and in the meantime, my stomach has swelled beyond belief and the pain is so intense it’s unbearable. I was to have the DMHC’s decision last Thursday and nothing. I called Friday and now they say they turned it over to another caseworker. And where is my current Oncologist who has not said a word to me since the 24th of May. NOTHING! When will it end? Is this all a game at the expense of my life? When my surgeon says he’ll do it for free? This weekend was the worst, so ill I actually thought I was dying. I called my wonderful surgeon and he says “in the hospital you go.” So I’m going, 10:30 am tomorrow morning and surgery will be on Wed/Thurs. The thing is I don’t have money …so I’m borrowing from friends and family to put the 10 to 15K down so the hospital admits me. Now they say the hospital will be around 40-50K if not more for the extra tests that need to be done. But right now, all I can think of is going in, having this surgery, getting well for me and for my girls and when I’m well, do everything in my power to not let this happen to anyone else. This is my promise.         ~~Elissa