• LMM's Avatar

    Health insurance carriers HMO to be specific. Has anyone had a problem with their health care provider approving treatment at cancer center

    Asked by LMM on Saturday, January 26, 2013

    Health insurance carriers HMO to be specific. Has anyone had a problem with their health care provider approving treatment at cancer center

    They are not contracted with. The doctors contracted with my provider requested a second opinion from Loma Linda University cancer center. I was cleared for the second opinion and met with the oncologist from LLMU. My current oncologist feels my case is very puzzling to him and his colleagues this why they wanted 2nd. LMMU's doctors stated they feel more qualified to treat me. So my ? Has anyone here been in this situation and if so were you granted permission to receive treatment from the more qualified facility?

    2 Answers from the Community

    • BuckeyeShelby's Avatar
      BuckeyeShelby

      I didn't have that problem, but I work for a 3rd part administrator for med & dental insurance. Every insurance company has an appeals process. You'll likely needto get your doctor involved w/copies of med records and a letter as to why that center is the best fit. Our co tries to turn appeals around w/in 30 days, but I'm sure every co is different. I'd give your insurance co a call to ask them procedures fo appeal, how to submit, what you need and how long it should take. And if the CSR gets nsty w/you, ask for a supervisor as the phone reps have no vested interest in whether it's approved. I wish you the best of luck.

      over 4 years ago
    • SueRae1's Avatar
      SueRae1

      I did not have that issue. I agree with Buckeyeshelby, find out about the appeals process.
      I have a friend was granted permission to be treated at a center that did not have a relationship with her HMO.
      If you have issues, you may want to seek legal advice.

      Good luck.

      over 4 years ago

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