The situation is so complicated that now there is a state HMO Help center for those who need help. The department of insurance also fields complaints. 40% are overturned in favor of the patient. Where does this leave the physicians – caught in the middle. What do they do in the meantime? Good question here. Of course there is a process to go through and it’s called filing an IMR (independent medical review) or of course you can always file a legal suit too after exhausting the steps in the process. Most of all, the support of your physician is important in the process. When things get real bad there is always media coverage too, which we have seen quite a bit of in the last couple years. BD
(06-22) 17:38 PDT -- Doctors are supposed to prescribe tests and treatments that are medically necessary for their patients. Health insurers are expected to cover that care, while keeping inappropriate expenses in check. But what happens when that process breaks down and sick patients are left to fight for medical care? Each year, thousands of Californians find themselves at odds with their health insurers over whether they, as patients, should get the treatment their doctors prescribed.