Okay, so far here is her story.

She's a woman in her 60's on SS Disability. She has an HMO. She has a lot of health issues, various conditions and is in the middle of going for tests, biopsies, etc. etc.

She was just told that ALL of her doctors are no longer in her network. They did not give her any notice. They just said "As of March 1, we are not in your network and if you come to us you have to pay"

Like I said, she is in the middle of all testing and such, needs more biopsies, and even her health care provider is not in her network anymore. Her prescriptions will soon run out.

I told her "you need to get a new health care provider immediately". Then you can deal with the rest of the stuff. You need to be able to get your prescriptions written". I then said "I don't think what they are telling you is legal, but I will post your problem on the forum and see what answers people come up with'.

So I think she needs to call a lawyer or advocate to advise her what her rights are.

She lives in Brooklyn, NY. Does she call the ACLU? She did call customer service for her HMO but she said they are useless and told her "you need the numbers of your providers?" ?????????????

What the heck (if anything) can this woman do? Does she have any recourse? Can these doctors who went off network, well can they bump her off like that? She has no rights here?

Any info will be helpful

Melody
P.S. I told her to write me a detailed explanation of what she was telling me so I could post here but until I get ALL the stuff, I figured I would run (what I do know) by all of you.

Who can she call?

Thanks very much

Melody

I feel so sorry for your friend. Unfortunately it is happening alot in this country;. Including in the medicare/medicaid area. Doctors aren't getting paid enough so they drop their patients.
If your friends Docs. are not in the HMO, they can do this. It may not be moral but they can. To find a new doctor quick, have her call her local hospital advocasy gourp. Almost all big hospitals have such an organization. They may be able to provide a new physician referral. Also the doctors she had, if they care at all should provide a referal to someone they know.
Womens resource centers also may have ideas to help. They too are in most big cities, even in local communities. Lastly there are the clinics, that are based on your finances, some are free clinics.
The important thing is for her to find a new PCP right away. As that is the doctor who makes suggestions on what specialists she may need.
I sincerely hope your friend is able to find a quality, compassionate doctor quickly. She must be very upset. You are a good person for trying to help her like this. I will keep both of you in my thoughts. ginnie

I hope she finds another doctor soon. That's just awful that they can drop patients like that.

One question......are they under any obligation to forward copies of her medical records to the new doctors? Seems like if they elect to stop treating her they'd have to send the records to the new doctor.

It is my understanding in a situation where the doctor denies a patients HMO, that they do return the records to the patient. Also they can forward the records to the new doctor. A patient has the right to all their records. I sure hope it works our for our friend here. ginnie

When is her birthday? I'm assuming you're talking about her supplement for Medicare? Do her current docs still accept Medicare? (She's not receiving Medicaid, correct?) Would she just have to go out of pocket the 20% difference? Testing and the like shouldn't be a problem, although she may have to go to a different lab.

She is on Social Security Disability and has a Medicare Advantage plan, hence she is using an HMO.

Melody