Question
What is the name of your state? CA
Okay long story short, my HMO is telling me they cannont process my claim because they have not recieved information they requested (copy of E.R. report and HIPPA waiver). I did send, and fax, multiple copies of what they requested, yet they are telling me they never recieved them. when i informed them that i sent them Express, and certified ( one each) and was looking at sig. conformation (was signed by Mr. xxxx at 10:47 a.m. on said date) she started to back peddle and tell me i could not send the information, it had to be sent by the hospital. i then asked her why had I recieved all the info. requests telling me to send it. there was a long pause, and then told me to call back in a week. i have since filed a complaint with them and they have thirty days to respond. what else can i do? i want to obtain an attorney, but for what? i am not suing them....yet
Answer
Most HMOs/Hospitals have "Patient Advocates". They are in place to help patients/members with problems concerning issues as you have. If you have not heard from your HMO to this date, check to see if they have this option available. The Patient Advocates are suppose to be "objective" in their dealings between a member and the HMO. It is also suppose to be a "free service". Try this and if that is not satisfactory, try the State Insurnace Commission. Good Luck!