Medical HMO Refuses to Let me get further help

[JudyElaine]

I'm fighting my HMO. I've been to court to get my HMO to let me to go UCLA, for a rare popliteal venous aneurysm I was diagnosed with last July, and I won. The court has ordered they authorize my referral to UCLA. But now my HMO has called my Dr to get him to send a letter to the courts saying he is rescinding his referral to UCLA. Thus giving them a right for appeal, on the grounds I have lost the support of my Dr. I feel so alone now. The Judge has ordered my HMO to authorize my being seen at UCLA. But I don't know what will happen, now that my HMO is appealing. What should I do if their appeal is granted? If I just give up and wait til it pops, it could be life threatening. You can read my story in the undiagnosed symptoms and Neurology communities. They won't let me post it here, as it has too many characters :). Sincerely, JudyElaine

[Amir Mostafaie]

Dear JudyElaine,

It seems like your current issue is with your Primary Doctor(PCP)!
I would try to find out, what is the basis of your PCP's rescinding his referral?
Doctors usually rescind referrals if
a) prognosis of the condition changes or
b) they were wrong in the first place.

You need to find out which one holds true in your case & take your next steps accordingly.

If your prognosis hasn't changed, you are likely to win again.

Sincerely,

Amir Mostafaie

[JudyElaine]

Thank you Dr. I was hoping you would say that. Cause I talked to my PCP, and he admitted my HMO had called and requested he send that letter. He knows nothing of this rare aneurysm or how it could be detected, except from the reports I have printed off for him. I won the State Fair Hearing, because the proper testing has been refused me, by the Dr's I was referred to and my HMO. My PCP says he has to agree with my HMO now, that all has been done that can be done. And will write that letter to the courts. The proper testing has NOT been done, and the Judge saw this after reading my story and facing off with the Medical Director representing my HMO. In asking the Medical Director, "Why wasn't the Ascending venogram done in the posterior position, as was ordered?", the Director replied it wasn't necessary". Even after reading the case report shown him. This hasn't changed. This is why the Judge granted my request to be seen at UCLA. And I really think they have no grounds for an appeal, even though I have lost the support of my PCP, nothing has changed. I figured this was the case, I am just glad to hear you say it too :).  Thanks for your time,

Sincerely, JudyElaine

[JudyElaine]

The Radiologist up here in Lake Isabella still insists she saw what she saw in her stand up doplar ultrasound. And has not rescinded her conclusion, that I do in fact have this rare, "Popliteal Venous Aneurysm" growing behind my right knee, and it could pop. Although she states, she has told them in her report, and there is nothing else she can do to help me. The court recognized her report, when the Dr's wouldn't even read it. And that also helped the Judge decide in my favor.

          JudyElaine