being cleerly blocked

Posted by cleerlyseeker @cleerlyseeker, Jan 7 3:14am

70 yr old male. Had a widowmaker 12/19, stented. presently Ldl 45, ApoB 47, tri 69, bp 114/70 so numbers excellent. Calcium score paid out of pocket/cardiologist refused to order, 898. I want to know my at risk soft plaque status.
Want the Cleerly test, cardiologist refuses to order "won't change treatment". Its info I want, fu. Regular provider refuses doesn't want to piss off cardiologist.
Local imaging center has a work around, requires an additional $800 expense for outside doctor to rx and interpret. The money means nothing, the attempt to force me into paying it means everything, so I am trying to figure out a way to switch cardiologists to one who will rx (wont be covered by insurance but imaging center requires an order).
So any ideas how to cardiologist shop within my Humana Medicare HMO? Tried to get office practice manage to call me, no luck.

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You have a right to a second opinion on your cardio care. Call Cleerly, and ask for a list of cardios in your area who work with the Cleerly test. Get a list of cardios on your Humana policy from Humana. Use those lists to find a Humana cardio who works with Cleerly, then tell your PCP you need a referral to that cardio for a second opinion on your cardio care. If your PCP refuses, call Humana and tell them you need assistance getting the referral. Let them fight the fight for you. Again, you have a right to a second opinion.

Best wishes,
Cookie

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@cookierockwell

You have a right to a second opinion on your cardio care. Call Cleerly, and ask for a list of cardios in your area who work with the Cleerly test. Get a list of cardios on your Humana policy from Humana. Use those lists to find a Humana cardio who works with Cleerly, then tell your PCP you need a referral to that cardio for a second opinion on your cardio care. If your PCP refuses, call Humana and tell them you need assistance getting the referral. Let them fight the fight for you. Again, you have a right to a second opinion.

Best wishes,
Cookie

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Cleerly is a sad excuse for a company with 0% callback or email response. Guess they are on the way out or just dont care.

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The only other thing I can think of is to get the list of cardios in your area from Humana, and then go down the list calling them and ask if they use the Cleerly test. But if Cleerly doesn't even answer, then maybe a different company who provides the same kind of test? Google Cleerly test alternatives. Sorry it's so hard to get the test. I've been through this sort of thing. Very frustrating.

Best wishes,
Cookie

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yeah so Humana not into cleerly, booked thru hearthealth their shill, will cost an additional $800. Criminals 1, hero 0.

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Another to investigate is HeartFlow, and then get a Boston Blood Panel (don't fully understand what this is, though … may just be a Cardio IQ advanced blood panel?)

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In a dramatic change of events the practice manage from Humana finally contacted me and seemed very sympathetic and promised to solve my problem so I called and cancelled the Hearthealth appt hoping I will get the referral for free.
Criminals 0, Hero 0

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I assume then that Humana Medicare HMO is a Medicare Advantage plan.
Those with Traditional/Original Medicare (Parts A, B and D) and a good Medigap plan can self-refer to any doctor who takes Medicare. You can change plans for 2024 next October. Unfortunately, people who don't start out with original Medicare may find their Medigap policy to be more expensive than if they had started out with it in the beginning, and the insurance company can refuse to take you if I understand correctly. But you would then be able to see any specialist you want without needing any referral.

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@vic83

I assume then that Humana Medicare HMO is a Medicare Advantage plan.
Those with Traditional/Original Medicare (Parts A, B and D) and a good Medigap plan can self-refer to any doctor who takes Medicare. You can change plans for 2024 next October. Unfortunately, people who don't start out with original Medicare may find their Medigap policy to be more expensive than if they had started out with it in the beginning, and the insurance company can refuse to take you if I understand correctly. But you would then be able to see any specialist you want without needing any referral.

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Agreed. I had advice from a friend in California who insisted i need medicare advantage because of california access issues, but here in Ky totally not necessary.
I get some distinct (I think?) advantages with my Humana plan, $600 annual OTC benefits, virtually no paperwork etc.
But I did mention, truthfully, not threateningly, to the practice office manager that I was thinking of abandoning the plan because of this issue. She seemed to understand my frustration, hopefully I will hear from her today.

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@cleerlyseeker

Agreed. I had advice from a friend in California who insisted i need medicare advantage because of california access issues, but here in Ky totally not necessary.
I get some distinct (I think?) advantages with my Humana plan, $600 annual OTC benefits, virtually no paperwork etc.
But I did mention, truthfully, not threateningly, to the practice office manager that I was thinking of abandoning the plan because of this issue. She seemed to understand my frustration, hopefully I will hear from her today.

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I am not knowledgeable about OTC benefits in your insurance. Medicare has an online tool to compare plans and people do well to check it every year. The differences in cost can be shocking.
I chose Traditional Medicare with a Medigap policy that I could take with me when I moved. I never see a bill from them. I then picked a low-cost Part D drug plan.
I have freedom to go whenever I want to any doctor that takes Medicare even out of State. Some 14 months ago I had an abnormal chest x-ray in Urgent Care. I went to local Pulmonologist skipping my primary care doctor and got immediate CT scan and PET scan, no waiting for approval, and then I self-referred to Mayo Clinic. I went from abnormal x-ray to lung cancer surgery in 7 weeks with Thanksgiving and Christmas in-between. That must be a record. Three months later I self-referred for a Consult and then an immediate cardiac stent at Mayo (I knew I had a blockage).
While Medicare Advantage plans are cheaper and include dental and vision benefits, one gives up choice of doctor and must obtain referrals from assigned primary care doctor thereby losing time. The Advantage plan's doctors can lack expertise in one's area of illness. My local Pulmonologist – even though not a small outfit – did not offer video assisted thoracic surgery and would have offered me more painful option. Advertising on TV does not explain all that.
Consumer Reports recently had an article with conclusion that Advantage Plans work for people with no serious health concerns who do not see a doctor often.

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Consumer reports is wrong in my case. Louisville is a small town, I often get same day appts for specialists-same day I said. I am covered for emergencies while traveling and I dont need a medigap plan.
Appreciate the insight though, personal experience is often the best example we can find.
Now, if I need to get top notch Mayo-clinic care I agree with your coverage 100%.

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