Re: My First GI doc appt!!
06/29/05 08:52 AM
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Sand
Reged: 12/13/04
Posts: 4490
Loc: West Orange, NJ (IBS-D)
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Quote:
I looked up this doctor's name and he isn't in my insurance plan! My insurance plan is good for nothing...we have very limited doctors to choose from and the ones that are listed are not accepting new patients, usually.
With many insurance plans you can go outside the network - it may cost more but your insurance will still often cover some of the cost. Also, most insurance plans have an appeals procedure if you believe something that should be covered isn't - if your plan's doctors are not accepting new patients, I'd say that's ground for an appeal. Also, I seem to remember you saying your doctor refused to order tests, which would also be grounds for an appeal. Further, if you're trapped in an HMO, there may be governmental (state) appeals processes available to you. (Doctors refusing to order tests is one of those classic "HMO bad" red flags.) Last, but not least, you can let your employer know that your insurance plan is not really working. If your employer is large enough, they could consider offering you a choice of plans in the future. Usually this means either bad coverage free/cheap to the employees or good coverage for a higher employee contribution to the premium.
One last thought: you could find out how much epa_ginger's doctor charges for a basic office visit and pay for one visit yourself if you can afford it. If he recommends further tests, you might have a stronger case for appeal to your insurance company.
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