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Help...having trouble with HMO stuff... Help...having trouble with HMO stuff...

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Unread 01-14-2004, 12:35 PM
Help...having trouble with HMO stuff...

I think I'm going to lose my mind! Okay, I know, if I lost my mind I wouldn't actually KNOW I've lost it wouldn't bother me then, but knowing I'm going to lose my mind is upsetting, lol.

Seriously...I'm getting one problem after another trying to get a referral to a pain management specialist and to a GYN oncologist. There aren't any GYN oncologists in our health plan (time to change that) so the referral will have to go outside the group...and I'm sure that's not going to go well because they'll say I could see a GYN. I already have a gyn...I've seen 3 of them, and none of them really are helpful at handling the severe endo issues. How do people get referrals to these doctors? Am I the only one with lousy health coverage?

I feel like I'm losing my mind. seriously...I'm in pain, I'm tired, I feel like there's no hope (I had an awful appointment with my GYN yesterday about the 'no hope' with my endo). Now I'm being weighed down by the HMO circles they've got me running in...and I'm so tired of it all. I don't know what to do anymore.
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Unread 01-14-2004, 02:57 PM
Help...having trouble with HMO stuff...

Dear RIta,

I had some troubles too getting approved for the Gyn/Onc. It doesn't appear there are any in my health plan let along New Mexico. My plan benefits stipulate that if the service is not available in network they must pay in-network rates for me to go elsewhere. It was not easy and I had to delay my surgery but eventually the insurance company approved it. I did have to have my Gyn write two letters, the Pain Mgt doctor write a letter and the Internist as well. It took months in the end but I finally have the approval number (yesterday).

So read your beneifts info carefully as to how they determine the service etc. With ours, if it is medically necessary and the service is not available in-network (which the letters need to state and explain) then they really have to approve. Mine was deinied initially because they said it existed in network BUT THEY COULD NOT PROVE IT or give me a name... so I think they were bluffing to see if I would just accept the first response.

Best of luck! Let me know if you need the Mayo Gyn/Onc.


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