 |
 |
I have had a terrible time trying to get my HMO to cover visits to a Parkinson specialist. I had been sent for diagnosis to an HMO approved neurologist by my primary care physician. It took 3 months of return visits before the neuro was able to make a diagnosis of Parkinson's (his first diagnosis was carpal tunnel syndrome). He gave me misinformation (eg. an MRI would definitely show if I had PD) and finally prescribed 15 mg of Permax as a beginning medication for very mild PD (a very strange choice). He also gave me no information at all about PD and seemed annoyed when I questioned him. Because of my negative experience with this general neurologist, I asked the HMO for permission to visit a PD specialist for a second opinion, evaluation and proper medication. The HMO refused, even though my primary care physician was extremely supportive of my request and I was suffering from depression over the whole situation. I went through three appeals - the last time meeting with a panel which included the president of the HMO. They continued to deny my request, but said I could submit to to binding arbitration at $500 a day (my treat). Instead I filed a complaint with the California Department of Corporations, which is the regulating body for HMO's in CA, asking for reimbursement of my initial visit to a PD specialist and coverage of future visits. I am still awaiting their answer. In short, I have not had good luck with my HMO - which incidently was recently given an A+ rating by our local newspaper in their recent ranking of HMO's. I feel it is important to see a PD specialist so I have been paying for my visits out of pocket. It is infuriating to know how cold-hearted the health care industry has become. In fact my last suggestion to the HMO was that they replace the heart in their logo with a dollar sign. Mary Sheehan ( 58 DX '96 )