[Convince HMO]

Author: Marlene (---.ip.theriver.com)

Date: 08-12-02 00:26


Lisa wrote a letter for me & my doctor (an electrophysiologist) wrote a letter to my HMO - he believes I need surgery. But first I had to do some homework. In my case, I had to search the web for BC/BS providers out-of-state. I first tried for Dr. Maron, but apparently he is not. Dr. Nishimura is, tho, thankfully, & I was able to get the pre-auth. I don't know for sure if my doctor was truly convinced there is no qualified doc in AZ to do myectomy - at first he balked at the idea of telling the insurance co. that. But I told him I did not want him to lie for me & then I gave him literature from the HCMA & loaned him "the book". Guess he came to the same conclusion after searching for someone (I had also told him I did not want to be experimented upon - 2 or 3 times was not enough experience). Anyway, I'm thankful! Sure hope your doc will do the same for you! Keep us posted.



[Re: Convince HMO]

Author: Jerry Salzman (---.indy.rr.com)

Date: 08-12-02 20:26


Thanks. I did see my electrophisiologist this morning and he agreed with me and is writing a letter. Maybe this will not be as hard as I thought.



[Re: Convince HMO]

Author: Lisa Salberg (---.dyn.optonline.net)

Date: 08-14-02 10:00

Marlene -

I am glad that your doctor backed you in your choice to go elsewhere, this proves to me his is a good doctor. We all know where our limits are and when someone can say "I do not KNow, lets find someone who does" I think they are the BEST doctors you can find!

If anyone else is in need of a letter from the HCMA for your insurance company please send requests to [email protected]. The letter states that HCM is a rare disease and in many cases travel to an expert provides the best quality of care in the shortest amount of time. (this translates to the ins. co's that it is cheaper to go to the best fast rather than running to have every test known to man locally and many many visits to a local doc.). Further the results of surgury/ablation when done in a local hospital compared to that of a specialty center are so much better on average and again equal lower costs to the ins. company in the long run.

We have had one insurance company tell us no, we demand a local doc...and in that case the person needed to have surgury twice! one in the local hospital and the second at a specialty center.

Best to all!