Health Insurance Plans

At my company, I have a choice of health insurance plans. We can pick between HMOs and PPOs, and I have been with the same Managed health plan for the past few years. It’s the plan that has the lowest Co-pays and the best Coverage, and the network of doctors is fairly large. The Drug coverage is good and the Affiliated hospital is close to my house. Unfortunately, I’m discovering that it’s also the plan with the largest Bureaucracy and patients can easily Get lost in the shuffle.

I have a Primary care physician, but like other plans, if I want to see a Specialist, I must be Referred by my primary care physician. I have been trying to see an eye specialist for a few weeks. I called my doctor’s office for a referral, but the nurse told me that I needed to first make an Office visit. I tried to get an appointment, but there weren’t any Openings for five weeks! I tried to leave a phone message for my doctor to talk to her about my situation, but she never returned my call. I tried several more times, and still received no response.

I finally decided to file a Grievance. I know that I have patient Rights, and that if I didn’t feel I was being treated fairly, I could file a complaint. I just hope that filing the grievance will get me a Resolution to this problem. I’d like to see an eye specialist before I Go blind!

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Health Insurance Plans