HMO Nightmare

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39 Responses

  1. Moneycone says:

    I can totally feel your pain Buck. Considering the amount of money these companies charge, you would expect a better system in place.

    Why not have one number and track everything through that?

    • Buck Inspire says:

      I always dealt with my PCP so I never felt this pain. There are so many moving parts. Insurance companies, medical groups, doctors, and specialists. They all don’t have the same information or one part misinterprets the coverage which grinds the machine to a halt!

  2. This sounds like a big hassle. I totally understand. Sometimes dealing with insurance is a nightmare. That was absolutely one of the worst aspects of my previous job. Hopefully, these are the only insurance problems that come up until your wife delivers!

  3. Money Beagle says:

    I’ve never done an HMO and stuff like this is precisely why. Our PPO mandates that you stay in network to get the best percentage payments, but it’s never been an issue to find a participating physician. Nothing having to jump through hoops like this, anyways. Good luck.

  4. krantcents says:

    I had HMO, my first year of teaching. Selection of the primary care physician is real important. Ask a lot of questions until you are comfortable.

  5. AverageJoe says:

    I agree with Krantcents. We had an HMO for many years, but luckily everyone we wanted was “in network” and we didn’t have a real choice of hospitals.

    This process you described seems like a lot of waste for the system. There’s got to be a better way….

  6. I work for a company that is a combination managed care organization/HMO. And Ive dealt with these issues in a specialists office, too. Trust me, the offices are as frustrated as you are not just being able to go by the insurance but having to go by insurance AND PCP. I know we were.
    But in addition to the insurance company regulations, each state has a number of laws regarding womens health and transition of care for pregnant women. No one wants to make a pregnant woman switch doctors.

    But I agree, start with your insurance company. Work with customer service, and if theyre not helping you, ask for more specific help. You have a transition of care specialist. She is going to be your best resource because this is what she does all day long- help people new to this insurance find the right physicians and service for them.
    If more serious things come up, ask to be assigned to a care manager. This person, usually a nurse or a social worker, will help guide you through any serious health issues, making sure that every step you are making is covered.

  7. What a nightmare Buck. I hope it is all resolved smoothly for the sake of your ongoing and pressing healthcare requirements. It’s stressful enough preparing for a new baby without the added stress of navigating through the insurance system.

    Health insurance should be a non-profit business. It’s the only humane way.

    • Buck Inspire says:

      Thanks Hunter! Would be nice, health insurance as a non-profit. Don’t think it will happen since there’s so much money involved, haha!

    • Depending on your state laws, health insurance may very well be a non-profit business. The state of WA does not allow any health insurance provider (not even the Blues) to operate as for profit within the state. However, companies have to make enough of a margin to pay their employees (including COL raises and merit raises) and the laws require gobs and gobs of money in reserves.
      As far as I can tell, unlike life insurance carriers who get to claim “acts of god” and not pay out life insurance when lots of people die, your health insurance company has to be able to pay is 50% of their covered lives all had to be in the ICU or undergoing cancer treatments at the same time.

  8. Arlee Bird says:

    What a huge hassle! I’ve never had any experience with anything other than Kaiser which I got on about 14 years ago when I married my present wife. Prior to that I had nothing and rarely went to the doctor. Now that I’m older I’ve required more medical attention. I love Kaiser as everything is convenient and self contained. My doctor is right next to the hospital and care has been excellent so far.

    Sorry you’re having so many problems. With a young growing family you’ll need good care for you and your wife and kid(s).

    Lee
    Have you heard about the A to Z Video Challenge?
    Blogging from A to Z
    #atozchallenge

  9. Jai Catalano says:

    When my wife got pregnant the second time our insurance had changed. We couldn’t use the same OBGYN. We decided to pay for her visits and work it out with her. We got lucky because 5 months into her pregnancy she got a new job with insurance that covered it all.

    Jai

  10. Insurance companies are ridiculous, the number of stories I hear like yours really makes me think if this will ever get better or if they will always try to find ways to make your life more difficult by adding hoops to jump through. Does it really have to be this complicated?

  11. What an awful experience. I am glad we don’t have HMO. Now, I don’t think I would ever select it even if I had to.

  12. Sorry to hear about your problem with the HMO. I’m trying to find an insurance for my mom and it is a huge pain in the rear. Ugh…

  13. All of this is better than the Army hospital where I delivered my first. I had a different doctor each time I went for a checkup and the doctor that attended while I was in labor said adios as I was being wheeled into the delivery room….ah the good old days!

    I’ve never dealt with an HMO and hope to God I never do!

  14. Anna says:

    Oh, insurance companies…they are all the same. They charge you awfully lot of money, and when you need their services, it turns out that you are not fulfilling their conditions, or just partly filfilling them. Gosh, I hope it turns out well for your wife after all!

  15. 101 Centavos says:

    Sounds like a frustrating experience, Buck. Hope it gets worked out for the best. Maybe there’s a special kind of purgatory for incompetent HMO administrators.

  16. Any updates? There is always some hassle with this stuff…

  17. Eric says:

    I used to have an HMO. While there were certainly a few conveniences, it seemed like they usually cared more about money than my health.

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