
<b>An HMO Saga

Petitioning for Coverage of Disputed Treatments</b>

Donna wrote:
I cannot get my GP or Gynecologist to give me a referral to MDA cancer center. They both said my Insurance would not allow it.(HMO) Advice?
I have to go to bed now as I have a bit of a hangover from my pity party(angry party?) yesterday and i can't possibly read or think another thing today! :) 


Doreen wrote:
Dick, Donna has LMS stage iv lung mets, needs referral to a sarcoma center, and sarcoma oncologist and her HMO doctors are refusing it. She lives in TX, needs information about Texas laws to make the HMO and its docs sit up and take notice.

Her doctors are really creepy and really do not understand LMS at all. [Her gyn onc allegedly said she didn't need surveillance...that the margins were clear and go home and enjoy.... and then was surprised that there were lung mets, as this was a uterine cancer...]

If I hadn't already cut my hair very short because of the chemo shedding, I would now be pulling it out in handfuls ANYWAY...
doctordee


<b>Dick's answer to Donna's HMO crisis</b>
<b>Dear Donna:

Get hold of the Texas Board of Insurance.
Consumer Information - HMOs
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Texas Department of Insurance - Complaint Forms/Insurance&HMOs
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[He here gives a contact that he worked with at the Texas Dept. of Insurance for HMOs, her fax and email, and her direct number. Their help line is 1-800-252-3439 ]

If you are going to see a Sarcoma Oncologist at M.D. Anderson ... here is the main M.D. Anderson link:
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Also for patient advocacy issues and information see these sites from the Patient Advocate Foundation
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If you file a complaint be sure that you also contact your State Representative, State Senator and U.S Congressman at the very least.

**If you write a letter and the HMO is resisting sending you to a specialist DEMAND that they provide you a list of physician/oncologists who "customarily treat" LMS rare cancer. VERY IMPORTANT.</b>

Dick 


If you don't live in Texas, find the State Department of Insurance for your state, and your state Senator, Representative, and Congressman.  They will very likely have an online presence.

doctordee
revised August 2005
