Wednesday, May 30, 2012
Help Me Howard: Insurance Dropped Doctors
When you sign up for health insurance you make sure they cover your favorite doctor. So what do you do if they drop your doctor in the middle of the plan. Can you drop out of the plan or are you stuck? It's the reason one couple called Help me Howard with Patrick Fraser.
Marlene Solender: "And we decided to use our vocation which is music."
They became educational entertainers talking about the great composers and then singing their classics to groups all over South Florida.
Marlene Solender: "People like Gurwinch, Rogers and Hamerstrong. People are loving it and were having a wonderful retirement."
Their hobby lets them break out in their favorite songs, but ask them about their health insurance and they will sing a different tune.
Chet Solender: "And now were stuck looking around for another doctors."
Last year, the Solenders had to pick their medicare insurance company. They chose one because it included their doctors.
Chet Solender: "I was so happy I was telling everybody about it I don't believe it this is a wonderful coverage."
They signed up for a year and then in the middle of the year...
Marlene Solender: "AvMed dropped the doctors."
Specifically, AvMed dropped the dermatologist who is treating Chet for the melanoma cancer on his neck and face.
Chet Solender: "And of course doctor patient relationship is very valuable and we been going to this dermatologist for years."
Chet called the insurance company to complain. They told him it was a business decision, but as a retired dentist he says its not the way he would have run his business.
Marlene Solender: "AvMed can make their business decisions they have a right to they are a company. However do it at the beginning so that the consumer has the ability to make a decision choose it, but don't change it during the plan year, because to me that's false advertising, that's bait and switch."
Well Howard, they signed up with an insurance company for a year because the plan covered their doctors. So can the insurance company drop doctors from their plan in the middle of the year?
Howard Finkelstein: "To be blunt, the rules and regulations regarding insurance are convoluted and confusing. But what does seem clear, while a customer has a contract with an insurance company, by law the company can drop doctors in the middle of the year if other doctors are available. And if you can show you need to to stay with your doctor for medical reasons, your doctor can file an appeal to keep treating you under your insurance plan."
When I spoke to AvMed, a spokesperson said they don't make changes lightly. That they continue to have an extensive network of doctors to serve medicare members in South Florida. That this decision will not affect members access or quality of care.
She added if members want to stay with their doctor, the physicians have to initiate the appeal by contacting their clinical staff who will then review it on a case by case basis.
Chets doctor could have appealed instead, Chet found another dermatologist that took AvMed and had the melanoma procedure done. Allowing him and Marlene to continue to do what they enjoy, entertain.
Marlene Solender: "And Chet and I are doing about I would say 15 to 20 shows every month all around south Florida telling these stories."
Patrick Fraser: "If your insurance company drops your doctor in the middle of needed treatment, ask your doctor to appeal. And if its an important procedure, the insurance company has 72 hours to make a decision. On a brighter note, if you want Chet and Marlene to entertain a group, their number is on our website at WSVN.com under Help Me Howard"
Got a problem you consider a classic? Don't break out in song? Contact us, we wont sing your praises cause we cant carry a tune but we can insure you hit the right legal notes.
CONTACT HELP ME HOWARD:
EMAIL: email@example.com (Please include your contact phone number when emailing)
REPORTER: Patrick Fraser at firstname.lastname@example.org
On a brighter note, if you want Chet and Marlene to entertain a group contact Chet and Marlene at: