HMO's Suck

[JoeGKushner]

So last year, when I moved, I changed my group id. This means that I have access to different doctors than I formerly did because they're all supposed to be closer to where I moved to.

They assign me a doctor and I don't change it. Okay, that's my mistake.

Last month, I'm suffering some pain and call the HMO to change my doctor to one closer.

"Well, have you seen your doctor yet?"

"No. I've never seen this doctor that you've assigned to me that lives three cities over."

"No problem. We'll switch it in the system and you can see this doctor you've chosen."

Call up the new doctor. "Nope. You're not on the list."

Call back HMO.

"Oh, you can't see that doctor this month. It'll have to be next month."

"But someone just told me..."

"Did you get their name?"

"Do I have to start auditing you?"

"Sir, I don't like the tone of your voice."

"Alright, set me down for my doctor please."

Call again this month. Still NOT on the list. Call back the HMO.

"Oh, well, it states that you needed to see a doctor immediately so we didn't make the change. You can see him in March though..."

At this point, there is much screaming involved.

So now I'm thinking it's time to either go to the hospitol and pay the deductable, which is less than if I see a doctor I'm not covered by, or start filing complaints with the BBB until they switch my doctor over and I can go see him.

 

[Thornir Alekeg]

Except that if your HMO is like most and you go to the hospital for non-emergency treatment without authorization by your doctor, they won't pay anything at all. Good luck. How far away is the doctor you have been assigned? You might save time in the long run going there over phoning the insurance company ad nauseum.

I've been dealing with my own insurance company over an unpaid claim from 20 months back. When I first started my new job, the insurance company gave me the wrong ID number. The number they gave me was for a traditional plan with a deductible and 80/20 payment, but I had signed up for the PPO with just a copay. They sent me casrds with the correct number a few weeks later, but my wife had already seen her doctor and given them the number with which they had submitted the claim. Each time I call about it, they tell me it was applied to my deductible. I end up explaning the situation, they tell me they will cut a check within two weeks. I call back a few weeks later and I get "we applied the amount to your dedectible." I didn't have a deductible, just a copay! I explain it again, Sonny and Cher's "I got you Babe" plays on the muzak and the cycle repeats.

 

[ghettognome]

I worked for one of the largest insurance companies in the nation, but by the time I left there, they started having procedures that you can go online to change your pcp and print a temp card till the new one came so it bypassed that problem. But being as large as they were they HAD to do things like that to beat out the compitition.

 

[JoeGKushner]

I just don't see how these large organizations can be so stupid, willing to put the burden of proof on the person PAYING for the service, and then complain about the rising cost of health care.

 

[MrFilthyIke]

Health insurance is the biggest fraud and scam ever legally pulled off.

 

[Guillaume]

Stories like this make me glad to have the medicare program that we have here in Quebec/Canada. Granted, we have other problems related to medicine, but at least that is not one of them.

Good luck with your HMO.

 

[JoeGKushner]

I was told in essence that if I needed immediate medical care that indeed, I should go to the hospitol.

Seems that when they called to change my doctor, on January 20th mind you, that the administrator of the doctor told them that they shouldn't change the listing because I still wouldn't be able to get in to see the doctor until Febuary, which is what I wanted.

Seems that the company has "some" doctors that will take you if you're not on the list. I asked, "Well, how do I find out which doctors are those."

"Oh, we don't have that information."

"Why not?"

"We don't ask it."

"Why not?"

"We just have the name, address, and hours."

"Why don't you ask if they take patients not on the list. Wouldn't that be a good thing to know."

"Sir, I don't like the tone of your voice."

Ah, good bless 'em!

 

[MrFilthyIke]

"Sir, I don't like the tone of your voice."

Must be on their phraseology sheet.

 

[redrocket222]

Hey man. Don't let these HMO companies screw you around. I should know, I threw thousands down the drain using an HMO for the last few years. The last straw was definately their customer service, if you can call it that, anytime I called with a question about my coverage, they treated me like an idiot who should know better. So I said screw it! I went with a non-insurance coverage with a company called Med Express. The service with them is superb in comparison. What's more, when I call them, I get a human being on the phone right away, none of this press one, press two crap. They don't provide insurance-style coverage (so for emergencies i have a cheap catastrophic plan) but they severely cut the cost of my doc & dentist appointments, and rx when I need 'em. If you wanna look into them yourself they have a website: www.medexpressbenefits.com

Hope I could help!

 

[der_kluge]

Oh man, don't get me started. I just went round and round with an HMO last week.

In February, I had my wife schedule me an appt with a doctor at a clinic to renew my prescription for Prevacid. Prevacid is like a super-powerful form of Zantac. It's an acid inhibitor. Without it, I would greatly suffer from heartburn all the time. The stay-awake-at-night variety. I take it every day. And will likely have to take it everyday for the rest of my life.

So, we go to the doctor, and I get a new prescription. She's actually cool, and gives me two, one traditional, and one specifically for mail order, which is cheaper in the long run.

So, since I'm now running low, and have no more refills left, I asked my wife to go fill it. She calls me on the phone. "There's a problem", she says. Apparently, my HMO in its INFINITE wisdom, decided that I should only get 68 pills per year. Yes, sixty-eight pills. WTF?

So, I had to go through some crap, but it finally got sorted out, and I ended up getting a couple of samples to tied me over. Yesterday, I picked up my prescription, and the pharmacist felt my pain. "If it's any consolation, I've spent all day dealing with problems just like this." And he was in the same boat that I was (which was reassuring) with regards to the number 68. "Why 68 pills? I have no idea."

Good lord. I could almost see limiting something like codeine, or vicodin to a certain number of pills per year. Those are class-1 drugs, addictive, and powerful. Prevacid controls my heartburn, and is non-addictive, and anyone who is on this class of drugs take them EVERY-FREAKING-DAY. I should sue them just on principle alone.