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Re: Managed care and lawsuits (long)From: Betsy Hyde (elishyde@connix.com)Thu Oct 14 20:08:23 1999
At 7:42 PM 10/14/99, charlie chambers wrote: >therein lies the rub. by deciding what is "necessary and appropriate", >aren't the companies practicing medicine? And if so, shouldn't they be >liable to civil action? I am in the midst of a letter-writing campaign w/ my HMO, the State Medical Society, my elected officials etc. Last winter I had a URI which got progressively worse. I ignored it, thinking it was viral, until I was terribly short of breath and developed a tachyarrythmia on minimal exertion (walking into the house caused a tachyarrythmia of 140's.) Decided I really needed to be seen by my primary care md. Called her office - they refused to see me...that day, the next day, any day. Why? I had never been seen for a well-visit/routine PE. They offerred me an appointment for a routine exam 3 weeks in the future. This doc's personal style was to establish long-term relationships with her patients, and refuses to see problem visits unless she knows the patient. (She had been listed as my PMD of record for 3 years). So, I went to a walk-in clinic that was listed in my providers manual. When I got there, a big sign said they had terminated their contract w/ my HMO. At this point, I was too sick to care, was dx'd w/ asthmatic bronchitis and pneumonia. HMO refused to cover the vist....why? A non-clinical person said it was not an emergency, nor did it require an urgent visit. So, I was too sick for my PMD to see, and not sick enough for the HMO to reimburse my visit to the Walk in Clinic. Breach of contract, perhaps?
-- Betsy Hyde CNM Branford, CT
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