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Re: [IP] Re: Humalog being refused by insurance??
Please read the part of Sue's message I've included at the end. Her
endo dropped out of the plan, but there is another endo in the plan though
understandably not one she prefers to try. HMO's generally require you to
foot the bill if you choose not to use a participating provider no matter
what you wish. Often, better doctors will opt out of plans even though it
has a very negative effect on many patients. One thing to do is to ask the
doctor to reconsider rejoining the HMO with the request to not take on any
new patients, and to bug the HMO to recruit more than one doctor in each
specialty. It's a downer, but HMO's operate this way. We're very lucky as
most of the really great doctors belong to the PPO portion of our plan, and
if we need to use one who's not, after a very high deductible, we may get
some reimbursement from the major medical portion of the plan.
Marj; Mike; and "Ace, the PP" (portable pancreas)
"Date: Thu, 27 Dec 2001 19:30:59
From: "Jerry Power" <email @ redacted>
Subject: Re: [IP] Re: Humalog being refused by insurance??
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!"
> when my endo dropped them, we now have to pay the full bill for him since
there >is another endo in my area on the plan
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