HMO's

[mar50]

Hi Dan - I wish I had seen your post earlier (I am from WNY), BC/BS was great, some co-pays but what I expected.  Hope you are recovering well at this point!!

[L Malik]

My surgery was on January 12th and I also had the BAHA attachment point implanted.  The actual sound processor will probably not be attached until May.

 My insurer is a PPO and I have received their letters, questioning pre-existing conditions and telling me that I was not eligible for coverage.  In each case, I called the customer service number on the back of my insurance card, with good results.  Make sure that you write down the date you called and the name of the person who talked to you.  In each case, I was able to talk through the problem and receive assurance that I was eligible for insurance coverage and that they would correct their records. 

After researching the on-line medical insurance contract on my office PC, I learned that sound processors were not included in the plan, but that was for 2006.  Things could have changed in the 2007 contract and I am prepared to dial that customer service number as soon as I see a declination of coverage for the BAHA in any statement of benefits that is mailed to me.  If this AN has taught me anything, it is to be patient and never give up hope.  Hang in there!

[SteveWWD]

I had an HMO and they denied my plea to go to the doctors that I wanted to go to.   So they gave me a list of five doctors that i could go to.  Lucky fo rme, the agent did not do what she was supposed to do and she just gave me the first fiev doctors off of a list.  I found out later that they are supposed to actually research what the procedure entails.  So they gave me a list of ENT's in family practices and one surgeon.  I went to all of their doctors, listened to them, and for all of them except the surgeon I asked to write me a letter stating that they cannot perform the procedure.  I also got a letter from my primary (which was basically my letter rubber stamped) and a letter from the doctors that I wanted to go with.  Well after a long headache, it worked!  My HMO decided to let these doctors be considered "in network"  for the dates of the surgery.  Good for me, good for my wallet.

[bpham]

I have BC HMO (California Care).  The question I have is that if I'm opted for a surgery, can I pick the doctors to perform it or they assign them to me?

Naturally I'd like to have the best doctors to do the operation.

Of course I will call BC and ask but usually if I know the options and ways to talk the them ahead of time it would help.  I'm pretty new to this so any detailed information would be very much appreciated.

Thanks.

[OTO]

My insurance is BC/BS Hawaii (a PPO).    My issue is that they have denied payment for several items on the House Clinic billing and have asked House to provide more information.  I'm hopeful that House and the PPO can work it out, otherwise I'm liable for $18,500 worth of service.... yikes....