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Re: [IP] Re: Humalog being refused by insurance??



Sue,

You are correct, I did misunderstand.  I have had several running battles 
with HMO's I have belonged to in the past, because they refused to provide a 
pedi endo for my son.  Most of the time they stated that a regular endo 
could provide the service, even though the endo doctor's refused to accept 
him.  After review of the t and c's and checking state law we forced the 
HMO's to pay for his visits, but I had to do it with 3 different HMO's.

Jerry


>From: "sue depinto" <email @ redacted>
>Reply-To: email @ redacted
>To: email @ redacted
>Subject: Re: [IP] Re: Humalog being refused by insurance??
>Date: Thu, 27 Dec 2001 21:29:35 +0000
>
>No Jerry, I don't think you understood. There are 3 endos in my area
>(Peoria, IL). I go to one who has an office with another one and they
>stopped being a part of that insurance plan. The 3rd endo has his own 
>office
>and he is still connected with the plan. When I was refused the option of
>using my current endo we did call the insurance co. and told them how I had
>gone to the other one and how unscrupulous he was (he ran a zillion tests
>every time you went in and charged a fortune and had absolutely no
>personality) it didn't matter. They still refused to pay for my present
>endo. Actually, the one who is still on the plan is the one who actually 
>put
>me on the pump and then left me stranded because he then told me that to 
>get
>me regulated he would put me in the hospital on a glucose monitor, but I
>would have to pay for it since he would make me go to a hospital that was
>not on the insurance plan. Yes, we told the insurance this too, as well as
>sending in a formal complaint. I also found out from MiniMed that he had
>ordered my pump several weeks before I even told him I would get it. Go
>figure!
>
>Sue (dalgal)
>
>----Original Message Follows----
>From: "Jerry Power" <email @ redacted>
>Subject: Re: [IP] Re: Humalog being refused by insurance??
>Date: Thu, 27 Dec 2001 19:30:59
>
>About your doctor not being covered by your HMO, this is a common trick
>pulled by the HMO's to not pay for specialists.  In most states, Texas for
>example, the HMO must either add an endo for your condition or pay full
>coverage for your current doc.  Call the HMO and verify their terms and
>conditions for medical conditions requiring a specialist.  Good Luck!
>
>
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