MedSolutions is no solution, Maybe you'll die first
MedSolutions review - Complaint
FRANKLIN, TENNESSEE -- MedSolutions is the third-party medical review company used by Cigna and many other insurance companies. If you are unfortunate enough to have insurance w/a company using MedSolutions be aware that your quality of healthcare has gone down.
While claiming they are trying to save money for the insured and prevent unnecessary tests exposing patients to radiation, they are actually keeping patients from receiving necessary tests and an accurate diagnosis, while lining their pockets.
After having surgery for cancer, I was having some problems and pain. The dr. ordered a CAT scan. It took a very long time to get approval, but we got it. The cat scan showed some seromas in the abdomen, but also found lymph node enlargement in the lower chest area. This was purely accidental, because it was an CT of the abdomen, and these nodes just happened to be right in the top of the image. So, my dr. said let's give it a month or so, see if the swelling goes down before I decide it we need to drain the swellings, and also see if the lymph nodes go down. This is standard medical procedure.
Six weeks later, we were supposed to have another CT scan, but after weeks of hassling w/MedSolutions, we were told they wouldn't approve it. They said it was unnecessary. Ok, so now the dr. doesn't know if the swellings have gone down. Is that important, yes. Sometimes they go away on their own, sometimes they calcify. Is it important to check the lymph nodes, of course. After all, we have a patient who just had surgery for cancer. Nonetheless, even after the dr. talked to the review committee, they said the scan was not necessary.
Finally, the dr. was able to get a CT of the chest, but not abdomen. So we will just hope the best for the abdomen and be grateful we got anything. This CT showed all lymph nodes enlarged and a virchow's node. A virchow's node is what is referred to as a signal node. A node that is a general marker of cancer. Granted, not always, but very often.
So a month later, upon reviewing the case, an oncologist says we need to do another scan and see if there's any change in the nodes. If not, we will do procedure in the chest for those nodes and a ultrasound guided biopsy for the virchow's node (which is in the area of the clavicle). He tells me to come back in a week. We told the Dr. about the hassles w/MedSolutions and he says they always question every test, but he doesn't order a test he doesn't need.
One week later, MedSolutions is still not authorizing a CT scan. I call MedSolutions myself and they say at the earliest they will make a decision, it will be several more days, and likely it will be denied. So, rearranging your schedule, taking time off from work, etc., is now another issue.
Now, I ask you this: How is a dr. supposed to know if surgery or a biopsy is necessary if he can't see what's going on? Should he just operate, only to find out that maybe the nodes are normal again? Should he just wait and hope that it isn't cancer and waiting several months doesn't make it worse?
And what about the patient? Who wants to have these tests? No one. Even if you are insured, you have to pay for them, take time off from work, go through the hassle, not to mention that the mere fact you're having them means there is a problem.
MedSolutions is no solution for patients and seems it's penny-wise and pound foolish. I think surgery is a lot more expensive than a CT. Maybe they don't have to deal w/hospitalization and surgery approvals, so the costs of those won't affect their bottom line. They can just let the patient get worse and then some other part of the insurance process will handle it.
My case is not uncommon, if you do a search online you will see a few others, but there are undoubtedly many more.