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        New Message Board Archives >> 2002 Posts >> Denial of claim by HMO
        
(Message started by: DJ_Barrett on Oct 3^rd, 2002, 9:35am)

Title: Denial of claim by HMO
Post by DJ_Barrett on Oct 3^rd, 2002, 9:35am

Back in Feb. 02 I had severe cluster headache, my worst yet, and had to ask my wife to drive me to the emergency room as I had suffered for over 2 hours and so no relief in sight. The doctor tried oxygen but to no avail. Eventually, I was injected with a narcotic painkiller. It took about 30 minutes to work but...it did! I was then driven home to bed. I was then off work for about 3 days. Well, even though I considered this an emergency, my HMO didn't and denied my claim for the emergency room visit. Meaning I have to cough up $550 to cover it! I appealed but was turned down. I had no medication in the house and, in my opinion, uncontrollable severe pain is an emergency. It even says so in the HMO manual I have. I still plan yet another appeal. I'm going to contact my doctor and might even submit some info from this web site to back it up. Obviously, they people who make these decisions have never suffered from this affliction. If I'd cut myself and needed a couple of stitches then it's okay to visit the ER. Having a horrible cluster headache, severe enough for me to bang my head on the ground, is just a routine annoyance and not an emergency. This is indicative of what is wrong with health care and particularly HMOs in this country.

Title: Re: Denial of claim by HMO
Post by echo on Oct 3^rd, 2002, 9:49am

That sucks! And if you banged your head hard enough during a dance and required ER trip for stitches, then they would cover it. HMO's just plain piss me off! >:(

Title: Re: Denial of claim by HMO
Post by RevDeFord on Oct 3^rd, 2002, 11:37am

Have your doctor write a "Letter of medical necessity" and send it to the HMO. In a perfect world, that should do it.

Title: Re: Denial of claim by HMO
Post by curtisdsc on Oct 3^rd, 2002, 12:02pm

True what Rev says. I had a situation with my newborn my doctor wrote up the paperwork worked like a charm.

I know what you mean echo. Sometimes for giggles I call my insurance company when I have routine appts for my family and ask permission to go. They dont see the humor.

Good luck

Title: Re: Denial of claim by HMO
Post by echo on Oct 3^rd, 2002, 1:40pm

Good one Curtis. I'll have to try that. It's kind of like playing with telemarketers.

Title: Re: Denial of claim by HMO
Post by DJ_Barrett on Oct 4^th, 2002, 8:58am

Thank you, RevDeFord. I'll try that. My doctor knows how crappy this particular HMO is and shouldn't have a problem helping me out.