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[IP] MAJOR insurance malfunction - help needed ASAP!

A question regarding what insurance CAN & CANNOT decide for you, & what to
do about it if they are stepping outside the lines:

My Mom is a Type 2, dxd. 3 years ago, considered brittle & thus far has been
on a variety of oral meds with no great success as of yet...she's sort of
"treading water" with them, but hasn't moved on to insulin yet.  (I'm
pushing for that - if she's going to be "treading" something, I'd just as
soon see it be something effective!)

At any rate, her employer (a school system) allows her to choose between
three different insurance companies for coverage.  Although she had been
fairly happy with the one she'd been on over the past few years, they
changed their listings of "covered providers" for the next school year, &
her doctor & hospital are no longer on their list.  In meeting with a rep.
for one of the other plans, she found that her doctor is not covered by the
new option either (he seems to be moving away from the HMO arrangements),
but the rep. said that it could be worked around...had her fill out the
paperwork listing another local doctor (one I went to years ago) who IS
covered by them, who could give her referrals/authorization #'s for her
appointments with her "real doctor" (who is a specialist in blood-related
disorders) & the bloodwork she regularly needs as far as testing & such go
at the local hospital.  Okay, that seemed complex, but workable, so she
signed on.

Well, she got her paperwork in the mail for the new insurance...they have
someone she's never heard of listed as her PCP & the hospital in the city at
the other end of the county (exactly where she does NOT want to go) down as
where she has to go for any kind of testing.  She contacted them & got the
royal runaround - they said upon checking, they had discovered that the
original doctor agreed upon was not actually covered with them the right way
(during the "signing up" process they had been referencing outdated
documents), so they assigned her another doctor (without attempting to
contact her in any way), & since she signed on with them she is pretty much
stuck with that.  After arguing about the ethical problems inherent in this
whole situation & getting nowhere, she was told to contact her "new" doctor
(per their decree) & see if his office would make the needed referrals, as
previously planned.  She called them & went through Round 2 - NewDoc's
office will NOT refer her to her own doctor unless she has cancer.  She
tried (to no avail) explaining to them that she has seen him for years
because of anemia, high blood pressure, diabetes, etc...made no difference -
cancer, or not at all.  Now she has an appointment with OldDoc scheduled for
July 10th, to check on how her new meds are working out (he took her off
Glucophage & switched her to something else...at this point I'm too fuzzy to
remember what), & the preliminary bloodwork for the appointment is set up
for the 7th.  Unless she can get this untangled to SOME degree & something
workable established in this next week, I'm afraid that either  a) she's not
going to be getting the medical care she needs (she's been hospitalized
several times over the past few years, needing emergency transfusions for
blood-related problems, which her doc is working hard to get on top of);  b)
she's not going to be covered at all for the medical care of the coming
weeks, & have a nightmare of bills that she cannot afford to be facing;
and/or  c) all this chaos is going to cause her high blood pressure to
skyrocket, & she's going to end up in the hospital again, under heaven only
knows WHOSE care!!!

ANY advice, ideas, specifics on how to handle this, what kind of "guns" to
carry into the fray, particular words/phrases to utilize, laws or insurance
regulations that might work in her favor...would be SO VERY MUCH
APPRECIATED!!!  She is not much of a fighter on most things - but this is
not one to take lying down...particularly on a gurney, in some hospital that
you DON'T want to be in!!  I told her I'd post this, & hopefully come up
with some form of ammunition.  Here's hoping...


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