Fighting Your HMO for Your Life

Take Note!

Could not have imagined the insanity of a friends journey with health care this last 4 months;  I am writing this a bit prematurely because the War is still on to get a diagnosis and I do mean WAR.

I expect that if I have a health issue that whatever needs to be done to find out what’s wrong with me will be done;  If you have a PPO that is most likely true.  If you have a HMO, specifically United Healthcare, that is not the way they see it.  Dollars and cents take precedence over your life in their eyes. Perhaps a malpractice death suit costs them less than treating you.  Somebody please explain the stinking thinking!   Without disclosing too much info about the health issue or the person I will do my best to give you the picture.

A person has a potentially life threatening illness (they physically see and live with the symptoms every single day…a constant reminder of time ticking away).

The person fights with the insurance company every day to approve tests that the Dr’s order to be able to diagnose this condition; every single day for the last 4 months.

After threats of law suits and pleading about how potentially life threatening the situation is; Deny, Deny, Deny.  Start your denial challenge it will only take another 25 days to get an answer after the 10 or so days we have taken to deny the test in the first place.  Oh you aren’t going to stop calling and threatening us.  The denial was sent in error…here, go have your way with this one.

If the initial thought process is accurate days matter to have a good potential outcome for this person.  Remember we are at 4 months and counting as I write this.

There are few options for what this can be, so the scope of the tests are fairly cut and dry.  Still no diagnosis and the test that could potentially give the answer has been denied as not medically necessary.  Mind you the test was ordered urgent by the specialist.  The day after it was ordered the insurance company downgraded it to non-urgent.  That gives you an answer of approval or denial in 5 business days instead of 24 hours.  When you call to check on the 7th business day you are told that they don’t have your files to determine the need and the 5 days will begin again from that point.  Finally they agree that they will give you an answer in 24 hours. DENIED..NO MEDICAL NEED FOUND.  Feeling at a loss;  no diagnosis, problem still exists, no way of getting the necessary test to determine a diagnosis.  You can now challenge, that will take 25 more days

Now you have to make hard choices to pay out of pocket…life or money.  Trust me it’s a tough choice when you have a family to support.  You feel short sighted (it’s our natural instinct)…without you to make money where do they stand…Big picture time.

Frustration cannot describe how I feel.

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2 Responses to Fighting Your HMO for Your Life

  1. Michelle Pacifici says:

    Your words are powerful, thanks for fighting!


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