HMO Help?

[MelissaM]

My HMO is telling me the only way they will cover follow up visits/tests from my hospital stay is if I go to Maryland and am seen by one of their physicians. This would entail 1 hr 45 min drive to go see a primary care physician, who will then give me a referral to see a local cardiologist. . .and 1 hr 45 min drive back to see that cardiologist.

Any suggestions on how to get to see someone local or avoid seeing a PCP first? Thanks,

Melissa

 

[Ross]

Nothing is going to be easy you for you now huh? I guess you have 2 choices, well maybe 3:

1. Get a hold of the benefits coordinator and plead with him/her concerning where your at and what they've told you to do would entail, then hope they will just approve it. Ask for an expedited appeal.

2. Pay for everything out of your pocket (Ouch)

3. Return home and get everything you need from there.

There just aren't any good answers when dealing with these HMO's.

 

[LUVMyBirman]

What Melissa????!!!! Now that is insane!!! Riding in the car for the first few weeks can be uncomfortable. Especially with an effusion. Been there.

Not to mention the potential danger of a prolonged car trip. Believe you need to get out every half hour in the early stages to make sure your cirrculation is in check. I would fight it tooth and nail. You don't need the stress. Ask a family member to call on your behalf and point out you are too weak to make the call. How on earth do they expect you to travel that distance to an appointment! If they deny you....worse case would be an out of network fee to cover the difference. Would be worth it for sure. On the bright side, at least you had the surgery where you wanted!

Hope you are feeling better!
Take care,

 

[Ross]

Bottom line Gina, they don't care about the patient, only their bottom lines. This is why I and many others hate HMO's.

 

[Nancy]

Don't they have out of state services?? Why can't you go to someone where you are right now and get a referral? What would be the difference if you were traveling and became ill, wouldn't there be some way to accommodate you? Or are they only located in that city? Doesn't make much sense. You are only in a different state, not on the moon. For Heaven's sake, have someone advocate for you, and have them talk to someone other than the telephone answering person, someone at a higher level.

Cost cutting is one thing, but being a horse's patooty is quite another.

 

[LUVMyBirman]

I fully understand Ross. Was just blowing off steam for Melissa. Also, the friend I almost lost to an "HMO" situation. Long story with thankfully a happy ending. The envelope is going to be pushed too far one of these days. Or should I say, further than it already has. Our government will have to step in to save face.

 

[MelissaM]

Thanks for the support. Mostly it is just a pain in the petootie jumping through hoops until they figure out for themselves what the right thing to do is (i.e., sending me to someone local). After many phone calls today, I am getting closer. At least got them from "we absolutely will not pay for a local cardiologist" to "you will have to pay for a local cardiologist initially, but we may reimburse you". Would like a more firm commitment than that before proceeding. I am slowly inching my way up the food chain and dealing with appeals now. Hopefully, they will remember me from the last time 'round (the whole CCF debacle) and remember it is just easier to capitulate than have me hounding them. . Have the contacts for the big guns, but would like to save those for a rainy day. Hopefully, the supervisor will come 'round my way tomorrow. In the meantime, you all have given me some great lines to use!

Cheerio for now!

Melissa

 

[Les]

It just hit me...the title of this post is an oxymoron. (HMO-HELP)
_________________
Les AVR '93 / '95

 

[MelissaM]

That's a good one! HMO Help = Oxymoron. Hee hee.

 

[Granbonny]

Melissa

Melissa

If I am remembering correctly...you are 3 weeks and 1 day out of surgery? I was very busy that week. Surgeon wanted me in for a follow-up.. I was fine..and Cardiologist.. the next day. He was the one who took me off my meds from hospital. Are you still taking meds from being released from hospital? I felt so much better when he told me to quit taking them. don't remember what type..but many..Only took my coumadin after that.. Bonnie

 

[MelissaM]

Good recall, Bonnie! Three weeks out today. Feeling good, just on some digitalis to keep my heartbeat in line. Otherwise, I am med free - yay! Follow up care got a little bit screwed up because of insurance (My insurance is based in Colorado, had surgery in Cleveland, went to the ER in Lancaster, and finally found a cardiologist my insurance will cover in Maryland - amy further east and I will be in England! ) , but it looks like that finally got straightened out. I will see someone on the 17th to do a follow up exam and echo. The scar is healing up nicely, with only minor muscular pangs and a bit of popping/clicking beneath it. The only other abnormality is being massively hungry the past few days. . .I feel like an eating machine. Here it is 11:17 pm, and I am thinking a midnight snack sounds good!!

Sounds like Betty is doing great in her recovery, too, huh?

Melissa =)

 

[bvdr]

Melissa,

You do sound terrific. If digitalis is all you are still on then you may soon be med free! I am so glad you were able to have a successful repair. Do you still need any pain meds? So it looks like you are an easterner until the 17th eh?

Were you able to work ahead with your business or is it more or less on hold? Just think back a couple of months and remember what is already behind you. Any chance at all that my surgery sister will make the reunion?