Ok round three about to begin with the HMO some questions

399 Views 4 Replies 3 Participants Last post by CerridwenLorelei, Jun 30, 2004

CerridwenLorelei

Discussion Starter · Jun 29, 2004

My old I knew how to fight and fight well. These people I am working the ropes I have and then some.
Twice I have asked for an IRO AND filled out the paperwork they sent me to request it. This last letter they AGAIN sent me the paperwork for an IRO ( independent review organization) if they aren't going to do it why bother sending me the paperwork? Anyway I will fill it out again notarize it again and send it to them and the State INS board yet again-but HOW do I get them to do it?

Where is a good link to search for a lawyer that deals specifically with sueing HMO's? I believe I am going to use my ERISA option though I have never had to and need to learn more about ERISA.

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shelbean91

· #2 · Jun 29, 2004

I don't know about your specific situation, but when I was going through appeals with my HMO- my doc did all the paperwork and filing. It took almost 7 mos from my first appt to get through all the appeals (it was eventually approved through the independant review board) but I didn't have to do anything.

Are they just stalling or are they saying they didn't get your earlier paperwork? If they didn't get it, maybe try to get an actual person with a real address to send it to- certified mail, so you have a receipt?

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CerridwenLorelei

Discussion Starter · #3 · Jun 29, 2004

except for what the kick ass (now gone) nurse sent to PROVE I have this and had been on this medication before going to this particular HMO. I sent the state board proof of the previous formulary where it wasn't Prior authorization required and date it changed.
I have proof of the paperwork I sent-priority mail with delivery confirmation on all sets of it...
Unfortunately I don't have 7 mos to wait.I am not sure how long they can keep giving me samples to keep me mobile. and and I don't have 1400.00 ( that would be 7 mos worth ) to fill it while they wait around.
And they confirmed they got the drs paperwork,,,ugh

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Marlena

· #4 · Jun 30, 2004

The biggest, best HMO atty in Texas at the moment is George Parker Young, in the Dallas area (despite the fact that he just lost a crucial case at the Supreme Court).

Here's a link to his website:

http://www.gpylaw.com/FSL5CS/Custom/Home.php

He probably won't take your case unless it's likely to yield everyone substantial dinero. ERISA will NOT yield substantial dinero, and frankly will make your HMO giggle if you try to use it. Young may have some suggestions, though. It's worth a shot.

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CerridwenLorelei

Discussion Starter · #5 · Jun 30, 2004

name last night and talked to the office today the office in Fort Worth guess he has two..
but I think ERISA may be a moot point I talked to the investigator on my complaint right after talking to the HMO who actually said/did something illegal
That was interesting ..
more later

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