Health Insurance Issues
Judy G's Article on Insurance Approval Overseas
Town looks overseas to curb health costs
Judy: "How I successfully lobbied for insurance policy changes to allow qualified surgery overseas."
Download pdf Article by clicking here
Healthnet HMO Experience
Unfortunately it is not good news if you have an HMO. In my experience, (I have Healthnet HMO) with an HMO you have to find a doctor within your network and also usually within a certain radius, mine was required to be within 50 miles of my home. The surgeon needs to be contracted with your insurance in order to qualify. When I was going through this process, it was prior to FDA approval so there were not many docs doing resurfacing let alone any in my area. They sent me to one at Stanford that claimed he did resurfacing but only did hemi-resurfacing.
Healthnet Letter from Consulting Ortho
This was the conulting Orthopedic Surgeons recommendation letter that pushed Healthnet to finally approve my request for hip resurfacing surgery with Dr. Amstutz. Unfortunately, they sent the letter to me on December 1, the day I was in surgery with Dr. Bose in
Vicky's Healthnet First Appeal Letter
Note: I copied this almost verbatim from Alan Ray, every single patient that I know of, that has used this letter has won their appeal.
Health Net
ATTN: Services Appeals and Grievances department
P.O. Box 10348
Van Nuys, CA 91410-0348
Dear Healthnet:
I have received a written notice, dated September 19, 2005, from Bay Valley Medical Group denying my initial request for pre-authorization for left hip surface arthroplasty. With this letter and attachments, the request is being re-submitted for further consideration as an appeal of the initial denial.
Vicky's Healthnet Second Appeal Letter
Health Net
ATTN: Member Services Appeals and Grievances department
P.O. Box 10348
Van Nuys, CA 91410-0348
01/05/06
Dear Healthnet:
I have received your written letter dated December 1, 2005 denying my request for surgery in India but approving it with Dr. Amstutz of JRI. I would like to appeal this due to the fact that, as noted in the timeline below, your letter to me did not arrive until after my surgery date of December 1, 2005, which I had previously revealed to you.
Medical Insurance Explained
Research done by the AARP Legal Department
Q. What does HMO stand for?
A. This is actually a variation of the phrase, "HEY MOE." Its roots go back to a concept pioneered by Moe of the Three Stooges, who discovered that a patient could be made to forget the pain in his foot if he was poked hard enough in the eye.