Medical Insurance

Topic(s): me
2004-05-19 23:39:17 PDT

My brother said it would happen to me. He said when I turned 27 that my body's aches and pains would be more frequent, and they wouldn't always be quick to heal. He was right.

My back has been aching for the last three months! Not my spine or anything serious like that. What aches are my shoulder blades, especially the left shoulder blade.

I did visit my doctor. He prescribed physical therapy, and directed me to a physical therapy clinic.

Forget the back pain. This is where the real pain begins - dealing with medical insurance.

I called the clinic with my prescription. The clinic said they needed a form from the insurance company. The insurance company needed a form from my medical group. The medical group needed a form from my doctor.

Each party had names for the various forms. But I don't think any of them agreed on the names. So that, for example, one party thought an authorization form was one thing while one party thought the same form was a prescription form.

Plus of course while calling my insurance company, I was forwarded around through several call queues. In the event that I did eventually find a human on the line, sometimes they could halfway answer my questions, and other times they could not at all answer my questions. For the latter, they would promise to call me back in ten minutes, and then instead called back seven days later.

It has been two months since my doctor prescribed physical therapy. I found out yesterday that my insurance will not cover my physical therapy at the clinic my doctor directed me to.

Apparently my problem stems from my insurance plan being an HMO plan. Meaning I can't choose my physicians or clinics. Except one problem - I specifically did not sign on to an HMO plan. I signed on to a POS plan specifically for the reason cited.

However, I have learned that a POS plan defaults to a HMO plan under certain medical groups. My medical group is one of them.

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