About Cherille Shelp Expertise I can answer most questions regarding group medical coverage and life insurance coverage. I can answer many questions about HMO, POS, & PPO plans and other employee benefits. I don`t know as much about Medicare but might be able to help. I do not know about Medicaid.
Experience Past/Present clientsUnion Trust Funds and Self Insured Employer groups.
Question I have been suffering from a ruptured disc and out of work for over one year. I have been bounced around from doctor to doctor within my HMO network (Healthnet). My life has been going to the doctor, waiting for the referral, waiting for the appointment, with usually not much luck, just more conflicting explanations, more prescriptions, more painful tests, and the pain continues. I finally was sent to a Neurosurgeon with the understanding that I have done everything else and surgery is the only last option. I was also at the point of wanting surgery to end my pain and get my life back. This doctor decided that I didn't need the surgery, was terribly rude and ordered more painful treatments as a band=aid, and once again here I am again waiting to get better on my own. I was able to get a one time refferal as a 2nd opinion for a great doctor within my insurances PPO plan. I loved him, he knew exactly what was wrong and couldn't understand why I hadn't had the surgery sooner. He agrees that I risk further nerve damage and arthritis by delaying. He seems to think I can fight my Healthnet insurance to have them cover the surgery with him. Can my primary help me push my case to the insurance to cover this out of my network, or put me into the PPO on an emergency basis?
Is there any way I can go to this wonderful doctor or am I out of luck? What should I do to get out of this life in limbo?
Thank you for any advice you can give.
Answer You can fight the HMO and request coverage. Present all of your medical history and information and have the doctor write a report. Maybe if they believe future care without surgery will be more expensive than the surgery, they will go for it.
Also, when can you change to the PPO plan? Usually on the annual renewal date they have an open enrollment. Change if you can.
