Communicating your concerns over needed health services not covered by your HMO.

A collection of letters that guides you, one step at a time, through the process of building your case for having your HMO cover health services you believe are necessary.

Your HMO is there to help you receive needed health services at prices you can afford. But what happens when your HMO balks at covering a medical service or procedure you believe is essential to your health? You need to fight for what you need and put it in writing. This logical and comprehensive collection of letters can help you find your way through the often frustrating and confusing jungle of health care.

The letters, all of which are Microsoft Word documents, allow you to easily personalize your concerns and communicate quickly and clearly all necessary information. You start with trying to motivate your primary care physician to provide the service, move on to your HMO customer service department, proceed to writing to your lawyer regarding your concern, and finally submit your concern to an HMO review board.

Don’t spend hours trying to compose a letter that will get results; rely instead on these professionally worded documents to state your concerns in a way that will give you the best chance to get the health care you need. Really take control of your health care plan, and let your HMO do the best job it can for you.

11 LETTERS INCLUDED WILL ALLOW YOU TO:

• State the problem for your doctor: tell your doctor about how treatment is not working
• Reach out to HMO customer service department: make the initial contact with your HMO
• Question the customer service department decision: express your displeasure with the HMO’s finding
• Alert key individuals to the situation: notify your insurance agent or company’s human resources department of your concern
• Submit outside findings to your HMO: inform your HMO of the results of an unauthorized second opinion
• Request your HMO pay for outside service: ask your HMO to pay for services you received from a nonparticipating physician
• Challenge your HMO’s post-operative decision: detail the reasons you think the HMO had you discharged too early after an operation
• Threaten your HMO with legal action: advise your HMO you are seeking legal action
• Write an attorney: inform your attorney of your problem and request a legal opinion
• Contact the HMO review board: pass your concern to the appropriate HMO review board and ask for their findings
• Contact the State Bureau of Insurance: outline the situation and request assistance in bringing it to an acceptable conclusion

TERMS AND CONDITIONS COVERED INCLUDE:

• description of illness or medical condition
• description of ineffective treatments prescribed by your primary care physician
• request for a second opinion
• statement of no acceptable treatment for your condition
• request for recommendation of action from HMO customer service
• dissatisfaction with HMO decision
• description of findings from physician outside the HMO network
• bills incurred from physician outside the HMO network
• description of surgery received for medical condition
• post-operative release date from hospital
• deadline for acceptable resolution before taking legal action
• fact list for attorney’s attention
• fact list for HMO review board’s attention
• fact list for the State Bureau of Insurance

Available as: downloadable letters collection

All contents reviewed and approved by experts.