Guest Posted February 27, 2004 Share Posted February 27, 2004 Have others had problems with HMOs not paying for things AFTER the fact and not granting "permission" for treatments that Drs in their own network suggest???? ANd not paying the amount the DR in their own network charged???? This is unreal to me. Elaine Quote Link to comment Share on other sites More sharing options...
ginnyde Posted March 8, 2004 Share Posted March 8, 2004 Believe it or not Elaine, we have not had one problem with our HMO, Aetna US Healthcare. I don't know how much muscle primaries have in this situation. Ginny Quote Link to comment Share on other sites More sharing options...
Candy Posted March 8, 2004 Share Posted March 8, 2004 Its amazing, but we didn't have any problems either. The one thing that our insurance company did was deny a PET scan until after the biopsy was done. Hugh's doctor ordered a PET scan on a Monday and the biopsy the following Wednesday. The insurance said it had to be the other way around which I found resonable. Quote Link to comment Share on other sites More sharing options...
Snowflake Posted March 8, 2004 Share Posted March 8, 2004 Elaine, Do you have a case manager? If your nurse/case manager is not doing the job (i.e. processing claims, validating treatment, etc.) ask for her supervisor. IF you have everything in writing (doctor referrals, okay for treatment, etc.), you have a case and can fight it... I believe that a paper trail is something that will stand up in court - mention Jeffrey Fieger Keep calling and going up the ladder until you can find someone that knows what the hell they're doing and is able to put your claims through. (I don't have an HMO, I have a PPO, but have worked with the dreaded HMO claim process when working for a neuropsychologist - what a nightmare!). Becky Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.