|
Member
|
|
Join Date: Jan 2009
Location: Paradise
Posts: 855
|
|
|
Member
Join Date: Jan 2009
Location: Paradise
Posts: 855
|
Quote:
Originally Posted by numb
Hi All,
Does anyone on this forum has UnitedhealthCare signature value HMO plan? Do you know whether or not it covers Ketamine infusion and SGB/LSB? Is it difficult to get the authorization?
I used to have BCBS PPO plan and i have the freedom to go to any doctors and i don't have any problems of getting the care so far. However, my employer only offer either Kaiser or Unitedhealthcare. I did not like Kaiser because i was not offer the care that i needed for my RSD. I was lucky at the time because i also had another PPO insurance. So if you can tell me about the Unitedhealthcare HMO, i truly appreciated your help.
Thanks.
|
Hi Numb,
I have been in the health care field for 23 years. I have seen many variations of HMO-style insurance companies. Incidentally, Kaiser is an HMO, the largest among them. Unfortunately, they mostly work the same in that you are sort of "sold" to the IPA or physician/group whom in turn are responsible for your case-care. Generally, the "group" gets a flat rate per month to handle your care. They get paid the same per month whether you go to the doc or not. So if you need more than the average Joe, you start to cost them money and consequently costly procedures will be denied. The "group" will have multiple reasons why it will be denied (i.e. standard of care, experimental, investigational) and will opt for the cheapest treatment approach possible which is usually delaying everything and placating you with palliative approaches (endless ibuprofen, for example). And when you get denied, the insurance company will have a toothless appeals process if you choose to persue it; perhaps even your state too. Since it is not fee-for-service and is capped, the standard is less quantity and quality of care so that more people may enjoy the same. It is truly a system of "less is more." This will also be the premise for pending single-payer system except there won't be an appeals process and the standard of care will be redefined to be that of cost-reduction, not based on quality of care and will decided on by the bean-counters, not the MD's. These are just my opinions only and based off of personal observations. There are of course, endless variations to the above and I am sure those who will tell you that their HMO is the cats meow!
Oh, and in terms of legal recourse, you can't sue an HMO (Knox-Keene Act)! Neat, eh?
|