HMO Helpcenter

[ReneeK]

Has anyone delt with the state helpcenter? I have Healthnet and surgery is scheduled for 11/30/10 at House, but last week I was told that my insurance company wants me to see another doctor that is "in" network I have filed a grivance with Healthnet and was also given the information to the state HMO complaint center. I should hear something this afternoon. My medical groups says I need to see a Dr. Frank Hsu a neurosurgeon at Loma Linda Medical Center, while they have a great reputation no one there can tell me the number of AN surgeries he has performed. I just love Dr. Friedman and for the first time after being diagnosed felt comfortable with my decision, but now with all of this happening I feel nothing but anxious and worried!!!!

[Sam Rush]

Have your HMO primary care provider call the Health Net medical director and explain that HEI has the best results in the world, and their negotiated fee will probably be the same. I am a AN pt. AND an HMO medical doctor and I had the exact same situation with a pt. of mine who I found an AN in.

The Health net director was not up to date on AN  statistics and I gave him the HEI numbers, 98% outstanding results with surgery, and he agreed to let the Pt. have her surgery at HEI.

      Your primary care Doc. has to be aggresssive with this. Show him my note.

Sam

[ReneeK]

Thank you!!! So what you are saying is my PCP needs to contact Healthnet directly?

[ppearl214]

....... explain that HEI has the best results in the world, and their negotiated fee will probably be the same. I am a AN

Sam

As you know and have noted here over time... there are also many other fabulous AN treating facilities in the States, such as Stanford, Mass Gen Hosp, Univ of Pitt, Barrows Institute, etc.  Please remember that although HEI is certainly quite reputable, there are also many other wonderful treatment centers for surgery and radiation for treatments of AN's as many patients on these forums can share (with their positive outcomes as well)....... and many that will also work with patients, even HMO, to help come to negotiated rates.  I know of failures at HEI as well as other locations, so it's up to each AN patient to leave no stone unturned in doing their treatment choice homework.  Multiple opinions are highly suggested and encouraged.

thanks.
Phyl