Author Topic: Referral Denied. Reason -Services are in the network  (Read 6048 times)

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Referral Denied. Reason -Services are in the network
« on: March 30, 2009, 11:36:02 PM »
I am in an HMO and have gone to 2 surgeons who indicated I'm not a candidate due to cysts.  I have received opions from Dr. De Smet and Dr Gross indicating I am a candidate.  I requested a referral from my PC for Dr. Gross.  My HMO refused stating there were services/doctors in the network.  My question.  Has anybody had this same experience and how did you overcome it (if you did)?

I plan to use the facts that no doctor in my network thinks I'm a candidate then the services don't exist for me in the network.  The other issue I have is that the doctors in the network don't appear to have the experience and I don't want to get corraled into a doctor with only a few resurfacings.  Any help is appreciated.


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Re: Referral Denied. Reason -Services are in the network
« Reply #1 on: March 31, 2009, 12:58:53 AM »
Hey Dfalkowski,
I have an HMO and was also told by surgeons I was not a canadate for resurfacing.I fought for 7-8 months and was able to go out of network to get resurfacing done by an experienced doctor who knows what he is doing.It was the fight of my life to get it approved and I wouldn't take no for an answer. E-mail me and I'll give you my # and I will let you know what I had to do to get it approved.

11-7-08  Bilat/Dr.Ball/ASR


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Re: Referral Denied. Reason -Services are in the network
« Reply #2 on: March 31, 2009, 04:09:22 PM »

Where do you live? I have an HMO ..... it took my doctor's office about 15 minutes to get the approval for resurfacing.



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