Guest guest Posted May 27, 2011 Report Share Posted May 27, 2011 Hi everyone, I'm ready to scream and so is my husband. After months of waiting, the HMO to which we belong - Brown & Toland - in SF, finally got back to us on our request to have an out of network specialist do the myotomy surgery husband needs. They have refused to let us go out of network even though they have no in network specialist for the surgery. They referred us to 2 in-network MDs who they claim are " qualified " to do the surgery, but 2 of the MDs on the list aren't even surgeons. The other is a general surgeon, and the other a cancer surgeon. This is all the more crazy making because our insurance company - Blue Cross -- will cover the surgery if Dr. Patti does it, as they would consider him " in network. " I'm so angry and frustrated and scared. We are right back at square one with all this. Meanwhile, my husband is getting worse, losing more weight, looking more haggard, feeling more and more depleted. I had no idea before this how much power an HMO has in the process. For once, the insurance company is doing the right thing, but the doctors are hanging up my husband's ability to get the right care.The HMO has been horrible to deal with. everything has to go through the primary care physician's office. No email, no names, no phone numbers of anyone we can contact directly at Brown & Toland. Lots of smoke and mirrors, and we have no idea what to do next, There's some sort of appellate process but I'm not hopeful. Has anyone been in a similar predicament? Advice? Anyone know how much the surgery costs in the event that we decide to suck it up and pay for a specialist ourselves? Sorry for the rant. Just feeling so hopeless right now. Thanks, in SF Quote Link to comment Share on other sites More sharing options...
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