medical tips

[Guest guest]

, I could not agree with you more. For anyone that is up against an HMO, here are a couple of tips. Get a copy of your members policy. Your members benefits and read through them. I mean really read through them. Call your member services dept. ask them what is the policy for referrals for testing and to see specialists. How long will it take for them to process that referral.

Under the Federal law that is now in place they have a set deadline. They HAVE to tell you in writing that they are denying you this test, specialist or medication. Also they have to give you the right to appeal this.

Now some of just don't want to hassle with this. But it is really worth the time and phone calls. Get the name, and employee # when possible, of who you talked to. Keep your records. It pays off.

It has been my personal experience that most of the time when a test or medication or procedure was denied it was because the doctors referrals person did not know how to right the justification for it. Now, under normal circumstances these folks deal with every day run of the mill problems. Which dose not include anything having to do with RP.

Tell the doctor, nurse and referrals person if they have any problems to give you a call and YOU will talk to member services.

If the member services person is rude or uncaring, get their name and ask to speak to a supervisor. Be as polite as possible and professional. And only bark and snarl when it is absolutely needed. But remember if you do bark and snarl you will have to back up your words.

I have Cigna, undisputedly one of the most difficult companies in the US. No kidding they rated in the top 5 for the nation. And I can get through all of there barricades.

Again, it usually falls back on the doctors office not righting the justification correctly. In a way that a none medical person would see the need to it. It is stupid, plain politics. But if all of us that are past 40 want to admit, we created a portion of this HMO nightmare. We voted it in to keep the soaring prices of medical insurance, doctors fees and the like under control. Granted it has gone to far.

But this can be fixed also.

R.

, thank you for the sample letter. I will be writing to my senator and congressman soon. I truly believe that this is a way to get info out to the public and get some of these insurances companies to get their act together. I waited 2 years for an approval for an MRI. That is outrageous. I'm sure most of us have been denied medical treatment in one way or the other by someone who is not a dr., let alone knows our case history. We must change this and let the doctors do their work.