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Marty Most of my career has been spent in emergency management. married no children. Find out more about Marty
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  • #1

    Referral

    Lisa, thanks for your incredible help in determining where to ask for a referral. Based on travel costs I decided on Tufts and had my GP submit a referal to my health plan (Capital Health Plan). They denied the referal saying that they do not have a relationship with Tufts and said I could submit a grievance, which sounds to me like bureaucratic dodge.

    I'm sure this is not new news to you. What do I do next?

    This really gets depressing. I don't think my local doctors have a real grip on HCM, and in the last two weeks, to complicate matters have been diagnosed with diabetes.

    Thursday I would up in the ER with vertigo, like I had when diagnosed with a stroke a few years ago. Well by morning I was released, still spining. Now, on Sunday night I'm starting to get back to normal.

    Needless to say I'm depressed and feeling abandoned by the medical community. At least I can whine a little here.

    Marty
    Marty Bishop
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  • #2
    Re: Referral

    I suggest two things:
    1. Find out who they do have a relationship with (if anyone) that Lisa recommended to you
    and
    2. file the appeal/grievance. it stinks to have to do the extra work, but this is like their weeding out process. If you really need the specialist, you'll bust your butt to prove it. The insurance company has an obligation to tell you how to file the grievance according to their procedures.

    good luck,

    S

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    • #3
      Re: Referral

      Call the inrance company and see if they will work with one of the other HCM centers listed on the links page.
      If not - write a dispute and get your doctor (GP) to back you.
      PLEASE do not give up....the worst case is that you will have to pay out of pocket for the visit. I know that is not what you want to hear... but in the long run you will benefit greatly from it!

      Be well!
      Lisa
      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)

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      • #4
        Re: Referral

        Marty,

        I had a HMO here in Indianapolis. They let me go to Cleveland for a consult, but said no to surgery there. I talked to the local surgeon and told him about the consult and he agreed that the Cleveland Clinic was best for me. All it took was one phone call from the surgeon telling the HMO that I needed to go to Cleveland, and the surgery was approved.

        Jerry

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