Quote:
Originally Posted by o2bponca
Does anybody have Aetna HMO? I was so thankful my local (in my network) vascular surgeon opted to NOT do my surgery (or even decide if I should have it) because of a lack of experience. So, he sent me to someone with more TOS knowledge and surgeries under his belt. The dr. he referred me to is Dr. Jeff? Ballard in Orange, CA. He's on Aetna's HMO plan, but not in my physician's group. Naturally, I had to get authorization through a request from my PCP just to consult with this "new" surgeon.
Apparently, my medical group physicians actually decide if the auth. will be approved and they chose to deny mine saying that I need to see someone in my group. But, what if there's NOBODY with TOS experience in my group? I don't want some Joe-Smoe doing it! Don't they understand it's a relatively rare condition that many physicians don't even know about? What if some doc with a big head on his shoulders decides he's good enough to do it, even without experience? Don't I have a say in who does it - somehow?
I guess I don't really understand how the whole HMO thing works in this situation (haven't had to deal with it yet). If anybody can help, please write!
UGH - I'm so frustrated, I want to scream! Thanks for listening.
Carrie
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Print out our docs list and show it to the doctor or fax it with a letter to the insurance co. saying, I have a rare condition and there are only certain surgeons with enough experience to do a brachial plexus release with scalenectomy (or whatever you think your surgery would be, if diff.), and for Dr. Annest they had the curricular vitae (spelling?) basically listing ALL of his experience and publishing in the TOS field.
Whenever dealing with Ins. Co.s, if you send a letter certified, this seems to lay a paper trail for a malpractice / bad faith claim, and they then do the right thing.
I don't know Dr. Ballard, and I lived in OC all of my life until just recently.
Hoag Hospital has a GREAT TOS PT, they don't push you, in fact, they know that ANY pain means, stop, with neuro TOS. Their knowledge was great.
I see you're in Temecula. Tell them to send you to Dr. Jordan - for our OC group, I think he was tops, for identifying what you have (diagnosis) and treatment options.
Unfortunately, we have to go many miles to find a knowledgeable doc and one who can write well. For surgeons, I suggest Denver. For the top docs there, they DO take insurance, and I know Dr. Annest's office works hard to get authorization.