Jude,
I know this fits your question personally, but it might help someone else in an
HMO also. I was in your same HMO since its existence until I went on Medicare
May 2006. Michigan Blue Care Network no longer has "territories". The HMO
allows you to cross what used to be the territory lines and receive coverage
from any provider who works with the BCN HMO.
I must have saved my Blue Care Network notebook just for you. This is from the
Winter 2004 booklet (page 22). " No more regions: you can select any
participating provider. It no longer matters what region you live in or where
your primary physician is located. You can select any participating provider
in our service area. Of course, its best to have one close to home, but you no
longer have to worry abour crossing regional lines."
My neuro was alway out of my PCP's region and the office manager gave me fits
each time she had to go through BCN's process. She and I hasseled for two
months over a referral. because she didn't know of this policy change. Maybe
its possible that your doctor's office isn't going the extra mile and they are
giving you the excuse of territory or regional lines when they are no longer a
problem. I hope this is the answer you need.
BCN phone number is 800-662-6667. They can tell you if this policy is still in
effect.
---- [EMAIL PROTECTED] wrote:
>
>
> Hi All and Frank,
>
> As usual, I need some advice and help. I am so darn mad I almost cannot
> stand it! (actually, can't STAND it, at all) LOL
>
> I think that most of you know I have been waiting and waiting to go to the
> seating clinic so that I can get my tilting/reclining wheelchair so that I
> can
> get out of this danged bed I have been in since December.
>
> Well, the telephone woke me up early this morning with the good news from my
> doc's office that all of this time the clinic they were sending me to is out
> of my HMO's territory!!! I hate ineptness so much...
> (anger)
>
> What have I done lately to hurt anybody? (feeling sorry for myself)
>
> I have been in this da____ bed (that I am so thankful to have) since the
> first of December with two broken legs, after being Paralyzed with complete
> TM
> for 4 years (for those of you who do not know this), and I want to get up
> and
> in my chair so badly I almost can't stand it!
>
> I can't sit in the chair for more than 1/2 hour because my legs swell inside
> the casts so badly and become so painful that I can't take it and have to go
> to bed in order to raise them.
>
> Besides that, I have a pressure sore inside the anal cavity (caused by the
> ischema (sp) bone) that bleeds profusely when I perform my normal bowel
> program. I was so looking forward to the new (my old one was stolen) seat
> for the
> new wheelchair...
> (feeling even more sorry for myself)
>
> I just don't know what to do any more. I need help with some ideas and
> answers. I don't know how to fight "city hall" any longer and am almost out
> of
> the strength needed to do it. It's all INSURANCE COMPANY and HMO'S, not to
> mention the SOCIAL SECURITY COMMISSION who have all of the power...They are
> in
> charge and what I/we say is of little or no consequence. I am getting so
> pissed!!! (anger)
>
> Why is it always one step forward and three steps back?
>
> Dr. Frank, I added your name to this email because you know what I need to
> say and who I mostly need to say it to in order to get something moving in
> the
> proper manner, by doing whatever it is in the proper order, addressing the
> right people! And, I want ACTION, now! What do I do, how do I do it, and
> who
> do I address my actions to? Help me, please!
>
> Some of you have already been helping from behind the List. Sally, the
> Nutritionist wrote a lovely letter addressing how the use of a new
> wheelchair
> that raises up above my cooktop so that I could take charge of making our
> meals
> using healthier foods (Dave does his best, but cooking is not his strong
> suit...), so that it would help by enhanced healing of pressure sores and
> stomach
> ulcers, my weight loss, and all over general health.
>
> People have been sending me loving support through the grapevine and I
> appreciate it all so very, very much. And I appreciate all that Dave does.
> He
> takes care of me all by himself...no one comes in to help and we can't
> afford
> to pay any type of service. He takes care of the animals, the house, the
> five
> acres, the laundry, all of my needs (staying up half the night last night
> because I had such deathly diarrhea I was in tears), and he works six/ten to
>
> twelve hour nights a week, at 54 years old. I don't mean ever to sound like
> I
> don't appreciate him.
>
> Anyway, I'm sorry for getting out of control with this. And for being so
> needy. But I am at my wits end and need whatever kind of help any of you
> can
> give.
>
> Peace and Prayers,
> Jude
>
>
