Author Topic: Regrowth + Massachusetts Referrals  (Read 929 times)

Sciare03

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Regrowth + Massachusetts Referrals
« on: April 20, 2017, 10:27:01 pm »
Hello all,
I am new to the forum and wish I joined years ago. A little about me:

Age:28
Surgery Date: January 2015
Surgery Method: Subocciptial Right Ear
Size: 2.5 x 1.8 x .05cm in aggregate
Hospital: NY Presbyterian Columbia Medical
Surgeon: Michael Sisti

Post-op check up #3: 08/10/2016 (tumor may be growing, will revisit in next check-up)
Post-op check up #4: 03/20/2017 (tumor has grown +/- 1/4" since surgery and will require gamma knife)

Since surgery, my job changed am now living in Massachusetts and my new insurance, Tufts-Advantage HMO, does  not cover Dr. Sisti.  I've spent the past four weeks trying to work the system and figure out a way to get Tufts to cover Dr. Sisti.  This has included several frustrating conversations with member service representatives and supervisors which recommended that I have my PCP send in a referral which sounded very promising at the time, but today I found out the referral was denied.  I don't think my PCP or NYP Columbia submitted a strong case or a strong reason why care should be continued.  Maybe I am at fault for not specifically asking them to put together a comprehensive request as to why Sisti would be the best fit for the continued treatment, at least in my eyes.  Either way I think that at this point with the regrowth that has occurred is significant and I should start looking for recommendations for doctors in Massachusetts that perform Gamma Knife.  Does anyone have any recommendations? 

Thank you so much in advance.
AN: 2.5 x 1.8 x 0.5cm right
Surgery Date: 01/2016
Technique: Suboccipital
Facility: NY Presbyterian Columbia Medical
Surgeon: Michael Sisti

Nick

ANSydney

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Re: Regrowth + Massachusetts Referrals
« Reply #1 on: April 21, 2017, 06:11:22 pm »
Welcome to the forum Nick.

Before surgery your tumor was 2.5 x 1.8 x 0.5 cm. (So, very different from maximum to minimum dimension.) How big was the tumor after surgery? How big is it now?

If you can get your MRI on disk, you can take a look at it and understand its dimensions.

Sciare03

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Re: Regrowth + Massachusetts Referrals
« Reply #2 on: April 22, 2017, 07:56:47 am »
ANSydney,

Thanks for welcoming.  That was the greatest dimension in aggregate of the removed volume. 
AN: 2.5 x 1.8 x 0.5cm right
Surgery Date: 01/2016
Technique: Suboccipital
Facility: NY Presbyterian Columbia Medical
Surgeon: Michael Sisti

Nick

ANSydney

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Re: Regrowth + Massachusetts Referrals
« Reply #3 on: April 22, 2017, 04:57:14 pm »
Nick, I'm having troubles with understanding you dimensions. What was the size pre-op and post-op (over 2 years ago), 08/10/2016 MRI and 03/20/2017 MRI?