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Question abiot HMOs


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Can SOMEONE explain HMOs to me. I thought the whole point is that IF you go to their dang Doctors and their dang hospitals, that they would pay for it all, as long as you got your referral thingies filled out. I am finding out that's not the case. WILL SOMEONE EXPLAIN!

I know that there are copays. Also wondering if this is normal: They can drop me if I am more than 60 days late with copays. Do other people also have lists of certain injectables etc that their HMO won't pay for?

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Bug your case manager. That's his/her job, to make sure it's coverable and covered!

Bottom line is HMOs are there to make money. If they foot the bill for your treatment/s, it's money out of their pocket (the reason for so many refusals). NEVER take "no" as an answer, keep appealing and keep pushing...(oh, yeah, and keep paying... :roll: )



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Guest bean_si (Not Active)


You have NO idea how many times I have had to re-submit claims to HMO. So far (knock on wood) after I write them a letter they end up paying.

Challenge EVERY decision they make. They keep blaming the doctor's office or the hospital - for instance - saying the doctor's office said I was seeing a doctor that only takes PPO. I would then talk to the doctor's office and they would show me that they submitted the claim in the correct doctor's name.

Also, over and over, they keep refusing to pay, saying they don't recognize the claim number (my SS#) that was submitted with the claim. I have checked with the hospital, clinic, etc. and once again they are submitting it correctly.

How in the world can these HMOs continue screwing up claims and messing with people's lives? Geez.

I know it's hard on you because who wants to spend their time fighting with the people who are paid to help you. That's another thing that bugs me. They're cretins.


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