Managing Managed Care
What to do when an HMO denies treatment or coverage
GET IT IN WRITING
Ask for a letter detailing the clinical reasons your claim was denied and the name and medical expertise of the HMO staff member responsible, to better defend your case.
KNOW YOUR RIGHTS
The plan document or your HMO's member services department will tell you how experimental treatments are defined and covered, and how the appeals process works.
KEEP RECORDS
Make copies of any correspondence, including payments and any reimbursements. Also, keep a written log of all conversations relevant to your claim.
FIND ADVOCATES
Enlist the help of your doctor, employer, and state insurance department to lobby your case before the HMO.
DATA: BUSINESS WEEK; ANDERSON KILL & OLICK
Return to main story
| 
