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August 22, 2006

How maddening are HMOs?

Hmo Don't answer that.  It's rhetorical.  Well, answer it if you want.  Don't let me tell you what to do.

I recently had a routine checkup with my primary care physician.  The good news, I'm healthy.  Well, mostly.  I did need a referral to specialist.  I'll spare you the details of what type of specialist and why, but fear not, it doesn't appear to be serious.  Phew!

I was told I would receive the referral letter in the mail.  Well, two weeks later, I still had not received it.  I called my PCP and they gave me the number for the specialist's office, and told me to call to schedule the appointment before the referral expires, which is on September 15.

I call the specialist, and they ask for my "IPA number."  What, you ask, is an IPA number?  Yea, I still don't know.  Apparently it would have been found on my referral letter, which I never received.  I call my Primary Care Physician and they don't know what I'm talking about.  Instead, they give me a referral number.  I call the specialist's office again, and am told that the referral number is useless.

So, round and round we go.  I call the PCP again, and get the IPA this time.  I call the Specialist's office once again (bear in mind here that each time I call I have to press several buttons on the automated system before I can get the person I just spoke with), and the earliest appointment they have is on September 29.  But wait, my referral expires on September 15.  "You'll have to call your primary doctor and have them request an extension."

I call my PCP, and they tell me they will get the extension.  Of course, I plan to call after September 15 to verify whether or not the referral was extended.  Lest I arrive on the 29th to find that they can't take me.  Geez, the freaking hoops you have to jump through for a simple appointment!

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Comments

Holy crap! What HMO do you got? I've never had problems with Kaiser...in fact, they've been pretty impressive...of course, the Doctors haven't been that great, but having everything in one place is nice...

Wow! I've never had that kind of problem either. My HMO (Aetna) does all the referrals electronically. When the cat scratched my eye the specialist had the referral in the time it took to drive from my PCP to the specialist's office (20 mins).

great eye opener - thanks - HMO is seriously not an issue you want to mess with...

Insurance CAN be maddening but they are a necessary evil nowadays. Living without it can lead to a financial catastrophe.
Jerry
www.leads4insurance.com

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