I have been playing Navigate the Healthcare Maze today. My acupuncture benefits for the year--18 visits--will be up soon. There's a provision for granting additional visits, based on medical necessity. I thought my acupuncturist had to initiate the process and asked her to do so. She made calls to both my HMO and the organization that they use to handle acupuncture claims, only to be told that I have to initiate the claim.
I spent 52 minutes on the phone today with my HMO, most of which was on hold while the rep tried to call my medical group--Cedars Sinai--which had the rep on hold. But I don't receive acupuncture from Cedars, so I have no idea why they have to speak to them. I again explained that Cedars doesn't seem to have any knowledge of my HMO's acupuncture benefits, at which point the rep said my acupuncturist should initiate this! Gawd! Who designs these systems and don't they pay attention to what's working and what isn't?
I don't have much knowledge of medical systems in other countries, but I have to believe there are better models. There is sooo much inefficiency in ours!
