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I Need Help!


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Shy Heart
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  • I Need Help!

    My insurance company has denied a request from my primary care dr. and
    my cardiologist for me to be seen at a specialty center (MAYO/CLEVELAND
    CLINIC). What do I need to show my insurance company to convince
    them to cover it? I'd really appreciate any suggestions at all.

    Thank you,


    P.S. I have the straight HMO plan.

  • #2
    File an appeal right away.
    If your primary and your cardioliogist have asked for the referal it is unbelievable that they are not doing it.
    You may want to have a lawer draft a letter to go with your appeal, you do have new rights to take legal action against your HMO's now....threaten to use it...
    I will be happy to draft a lettter for you as well send me a PM with all the infromation re: name of comapny address and any contact information.

    ALSO - remember if your INS so says NO that just means they will not PAY...you can still go it will just cost you (I know nobody wants to pay - BUT if it is a matter of quality of life or life itself....it may just be worth it)

    Knowledge is power ... Stay informed!
    YOU can make a difference - all you have to do is try!

    Dx age 12 current age 46 and counting!
    lost: 5 family members to HCM (SCD, Stroke, CHF)
    Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
    Therapy - ICD (implanted 97, 01, 04 and 11, medication
    Currently not obstructed
    Complications - unnecessary pacemaker and stroke (unrelated to each other)


    • #3
      insurance company denying

      Have your cardiologist call personally. They need to be pro active with these people. He should say " so what you are saying is that you are denying my patient the best medical care he can receive and compromising his / her health. The medical offices I have worked in and managed this technique usually will work. Insurance company cannot control our health. No matter how much they want to. Midge. Don't get me started on this I get very nasty.

      Diagnosed in 1977, Myectomy in 1981 @ Mayo Rochester
      ICD&Pacemaker 1996
      Heart transplant March 19, 2004 @ Mayo Rochester
      Mom of Kaye.


      • #4


        You do need to act soon and you do need to put it all in writing. Calling is not going to win you an appeal ---it has to be in writing and a letter inidicating you know your legal rights is imperative at least and from a lawyer at best.

        Take Lisa up on her offer --she has 15+ years of HR management under her belt. She knows what buttons to push.

        take care,



        • #5
          In my experiences with getting an insurance company to pay for an out of network doc. It took a letter from my local cardiologist that stated that if I did not go and see these doctors that it could mean life or death. They approved it immediatly! Maybe that will help you!

          Mary S.


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