Denied Medical Care?
June 5, 2000 -- Nothing can be more frustrating or confusing than to show up at your doctor's office with symptoms of a health problem, only to be told you can't get the diagnostic test you want, a referral to a specialist, or a specific medical treatment.
Administrative appeals and legal recourse are possible long-term remedies, but in the meantime your health or life may be at risk. Although it's possible to beat your doctor or even your health plan in court, experts say patients are better off if they can settle such disputes without involving the legal system.
"Consumers who have health or medical problems often feel overwhelmed or powerless, and it can be intimidating to confront your doctor or health plan," says Bridget Sheehan-Watanabe, health policy analyst and staff attorney for the Center for Health Care Rights in Los Angeles. "But once a consumer has an understanding of how to resolve the issues and knows where the problem lies, she can often be successful in getting the care she needs."
Before requesting an appeal ?- which can take several months to resolve ?- experts suggest a number of initial steps to expedite the process. Contacting an attorney can also help. The presence of an attorney and the threat of a lawsuit may make the doctor, hospital, or health plan take notice, experts say. Moreover, "Everything is negotiable," writes consumer advocate Jamie Court in his book Making a Killing: HMOs and the Threat to Your Health. Here are some tips:
Loren Stein, a journalist based in Palo Alto, Calif., specializes in health and legal issues. Her work has appeared in California Lawyer, Hippocrates, L.A. Weekly, and The Christian Science Monitor, among other publications.
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