Tuesday, December 31, 2013

Head to head with our HMO

I must correct something I wrote about our inter-disciplinary assessment at the CP clinic last week. I gave credit where it wasn't due: our medical insurer (HMO) is now refusing to foot the bill.

We had applied for coverage only two days prior to the appointment since I had forgotten that we had made one. Normally, it takes five days to receive approval. Rather than cancel the appointment, however, we took the risk, leaving a check at the clinic with the proviso that they would not cash it for ten days. I was confident that we would eventually receive approval and insurance coverage. They had done that without a hitch the two previous years.

Today we learned the HMOs verdict. The pediatric neurologist it employs to decide all neurology-related issues for all the children in this city, all by himself, gave us a "No". He is only authorizing the orthopedist component of our visit to the multidisciplinary clinic.

The secretary at the local branch of the HMO was kind enough to send the SOB - with whom we have grappled before - a note which I dictated to her. In it, I crawl and beseech him to change his mind. I remind him how much money we have saved the HMO over recent years with our devoted care of C. I point out that the fund has profited  enormously from the fact that C. has, thankfully, not needed hospitalization or emergency room visits. Many children with impairments as profound as hers need hospital care every few months.

If the diabolical doctor digs his heels in, we take the matter to the government body that supervises HMOs. Apparently, within the HMO itself, there is no avenue for appeal against this man. He is so notorious that articles, TV documentaries and even ad hoc parents' groups against him have surfaced over the years.

All to no avail.

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