Need advice. And support

So sorry you are having to deal with a dreadful disease and horrible insurance company execs at the same time, John.  I would fight with the company personally, but your best advocate who can justify your need for a specialist is the doc who referred you.  They can call and/or write a letter of appeal that notes the standard of care required for a patient with your diagnosis….even if it necessitates your seeing someone outside "the network".  Sadly, primary care providers are very familiar with this process and should be willing to help you.  Yours, Celeste

So sorry you are having to deal with a dreadful disease and horrible insurance company execs at the same time, John.  I would fight with the company personally, but your best advocate who can justify your need for a specialist is the doc who referred you.  They can call and/or write a letter of appeal that notes the standard of care required for a patient with your diagnosis….even if it necessitates your seeing someone outside "the network".  Sadly, primary care providers are very familiar with this process and should be willing to help you.  Yours, Celeste

So sorry you are having to deal with a dreadful disease and horrible insurance company execs at the same time, John.  I would fight with the company personally, but your best advocate who can justify your need for a specialist is the doc who referred you.  They can call and/or write a letter of appeal that notes the standard of care required for a patient with your diagnosis….even if it necessitates your seeing someone outside "the network".  Sadly, primary care providers are very familiar with this process and should be willing to help you.  Yours, Celeste

John,

You should absolutely appeal this. If you call your HMO they can give you instructions how to start the appeal process. See if you can get somebody at Seaview to shoot you an email that you need to be seen by somebody else so you have a hard copy to work off.   Start a file and keep copies of every correspondence you have. The process can be brutal but worth it when you prevail, which you will if you attack this the right way. UnitedHealthcare is my insurance carrier and they were ok for getting treatments but horrifying to try to get reimbursements from for out of network Dr's. It's interesting how UnitedHealthcare wouldn't allow you to get a name of anybody in appeals or even a phone number but they just give you fax numbers that didn't work 90% of the time. Keep a very solid file and if needed be prepared to send it to your states district attorneys office or the state insurance commissioner. Always follow up with the insurer in a timely fashion and don't be surprised when they lose your file, say they need more information but of course neglected to tell you they needed something. Another way to get attention is explain the situation to your employers human resources person who handles medical benefits. I'd bet yours, like mine, would be happy to reach out to their contact and let them know that they are an interested party. If they get rough on you send your company's CEO an email explaining how poor his ill employee is being treated and you need his help. Getting through the melanoma is a full time job and this insurance stuff is pretty disgusting but if you stay organized and diligent on it you should be able to get what you need. Try your best to be very honest and very firm but don't start screaming at these people. Most of them are idiots who are poorly supervised and are living paycheck to paycheck holding people like us off from getting approved or paid for treatment. After going down this road so many times I always ask for the supervisor immediatly as they have more experience and understand what you mean when you tell them that your file is going to your CEO, the state insurance commissioner and the district attorneys office. Good luck. Keep the faith. Stay on it. You'll get there. 

John,

You should absolutely appeal this. If you call your HMO they can give you instructions how to start the appeal process. See if you can get somebody at Seaview to shoot you an email that you need to be seen by somebody else so you have a hard copy to work off.   Start a file and keep copies of every correspondence you have. The process can be brutal but worth it when you prevail, which you will if you attack this the right way. UnitedHealthcare is my insurance carrier and they were ok for getting treatments but horrifying to try to get reimbursements from for out of network Dr's. It's interesting how UnitedHealthcare wouldn't allow you to get a name of anybody in appeals or even a phone number but they just give you fax numbers that didn't work 90% of the time. Keep a very solid file and if needed be prepared to send it to your states district attorneys office or the state insurance commissioner. Always follow up with the insurer in a timely fashion and don't be surprised when they lose your file, say they need more information but of course neglected to tell you they needed something. Another way to get attention is explain the situation to your employers human resources person who handles medical benefits. I'd bet yours, like mine, would be happy to reach out to their contact and let them know that they are an interested party. If they get rough on you send your company's CEO an email explaining how poor his ill employee is being treated and you need his help. Getting through the melanoma is a full time job and this insurance stuff is pretty disgusting but if you stay organized and diligent on it you should be able to get what you need. Try your best to be very honest and very firm but don't start screaming at these people. Most of them are idiots who are poorly supervised and are living paycheck to paycheck holding people like us off from getting approved or paid for treatment. After going down this road so many times I always ask for the supervisor immediatly as they have more experience and understand what you mean when you tell them that your file is going to your CEO, the state insurance commissioner and the district attorneys office. Good luck. Keep the faith. Stay on it. You'll get there. 

John,

You should absolutely appeal this. If you call your HMO they can give you instructions how to start the appeal process. See if you can get somebody at Seaview to shoot you an email that you need to be seen by somebody else so you have a hard copy to work off.   Start a file and keep copies of every correspondence you have. The process can be brutal but worth it when you prevail, which you will if you attack this the right way. UnitedHealthcare is my insurance carrier and they were ok for getting treatments but horrifying to try to get reimbursements from for out of network Dr's. It's interesting how UnitedHealthcare wouldn't allow you to get a name of anybody in appeals or even a phone number but they just give you fax numbers that didn't work 90% of the time. Keep a very solid file and if needed be prepared to send it to your states district attorneys office or the state insurance commissioner. Always follow up with the insurer in a timely fashion and don't be surprised when they lose your file, say they need more information but of course neglected to tell you they needed something. Another way to get attention is explain the situation to your employers human resources person who handles medical benefits. I'd bet yours, like mine, would be happy to reach out to their contact and let them know that they are an interested party. If they get rough on you send your company's CEO an email explaining how poor his ill employee is being treated and you need his help. Getting through the melanoma is a full time job and this insurance stuff is pretty disgusting but if you stay organized and diligent on it you should be able to get what you need. Try your best to be very honest and very firm but don't start screaming at these people. Most of them are idiots who are poorly supervised and are living paycheck to paycheck holding people like us off from getting approved or paid for treatment. After going down this road so many times I always ask for the supervisor immediatly as they have more experience and understand what you mean when you tell them that your file is going to your CEO, the state insurance commissioner and the district attorneys office. Good luck. Keep the faith. Stay on it. You'll get there. 

I am so sorry to hear you're going through all this aggravation. You've been given good advice about appealing this.

Your experience is precisely why I refuse to deal with HMOs. If it's possible for you, your next option might be to consider switching from the HMO to a PPO. HMOs may be fine for run-of-the-mill conditions but as you've already learned, yours is anything but run-of-the-mill.

I am so sorry to hear you're going through all this aggravation. You've been given good advice about appealing this.

Your experience is precisely why I refuse to deal with HMOs. If it's possible for you, your next option might be to consider switching from the HMO to a PPO. HMOs may be fine for run-of-the-mill conditions but as you've already learned, yours is anything but run-of-the-mill.

I am so sorry to hear you're going through all this aggravation. You've been given good advice about appealing this.

Your experience is precisely why I refuse to deal with HMOs. If it's possible for you, your next option might be to consider switching from the HMO to a PPO. HMOs may be fine for run-of-the-mill conditions but as you've already learned, yours is anything but run-of-the-mill.