<b>An HMO Saga</b>

	I cannot get my GP or Gynecologist to give me a referral to MDA cancer center. They both said my (HMO) Insurance would not allow it.  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! :)  donna


Dear Donna,
 I suggest that you tell your GYN and your GP both:

 "If you are stating that you are letting the HMO decide what is medically
 necessary for me on the basis of finances, then you are ripe for a
 malpractice suit.  I suggest that you justify this referral medically, and
 let me worry about suing the HMO instead of suing YOU. "

 "The AMA has specific guidelines about second opinions, here they are" 
This website's discussion of &&url
The AMA listing of &&url  
PRINT THESE OUT AND HAND COPIES TO YOUR DOCTOR/S.

 "If you do NOT know that sarcoma centers have much higher survival rates for
 their patients, and CONTINUE to make it difficult for me to be seen at one,
 you are seriously not practicing medicine correctly, and I will report you
 to the state medical board as well." 
&&url PRINT THESE OUT AND HAND COPIES TO YOUR DOCTOR/S.
[You can do a Google Search to find your state's medical board contact details.]

And change them for better doctors, if at all possible.
Get in touch with the HMO management and DEMAND that they provide you a list of physician/oncologists who "customarily
treat" LMS -- a rare cancer.  Send them copies of the References as well.
I am writing to Richard, who lives in your state, for further information on a plan of attack.   doctordee


Richard, 
	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.
	   doctordee


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

Get hold of the Texas Board of Insurance,
&&url

Texas Department of Insurance, 
&&url

Texas Department of Insurance,
&&url

[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 that would most probably be M. Andrew Burgess.    If a surgeon Dr. Pisters, radiation either Dr. Ballo or Dr. Zagars. &&url  
Also for patient advocacy issues and information see these sites from the Patient Advocate Foundation
&&url
&&url

If you file a complaint be sure that you also contact your State Rep, State
Senator and U.S. Congressman at the very least.

<b>**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>     
Richard



Medical Provider Groups (who contract under the HMO’s) have patient advocates or case managers. They can help with your insurance problems and advocate for treatment coverage by providers who are not with your assigned provider group [for Sarcoma Specialists or clinical trial lab and scan and hospital costs.  You would call your HMO provider group to request a case manager be assigned to you.