December, '99 | Briefing | Mail | Don't Say This | Articles | Other Places | Archives | Send Mail | Ed Dewke | Legal Stuff

HMO Denying Therapies
from Lisa K.

Hi Ed! I wrote to you earlier this month to thank you for the book you wrote and the discovery of your wonderful website [Derm Didn't Tell Me About My Neighborhood Treatment Center]. I have since joined the NPF and have made friends with a few flakers! It has helped just having someone to talk to that understands. Lots of advice has been offered, but all sooooooo different. Some people say no red meat, some say don't use soap, some say use soap! Sheesh ... it makes my brain spin!

I have finally gotten a little bit of courage and have shared with a few of my co-workers about my P. They all said, "Thank goodness, we just thought you had a HORRENDOUS case of dandruff and we didn't know how to tell you." I feel it ironic they are relieved I have an incurable disease as opposed to a treatable condition!

Anyway ... here is the discouraging part. Remember I discovered the Macomb P Center in Michigan is just miles away from me and I never knew it (see Other Places here)? Well, I went to my General Physician (I have an HMO), and he wouldn't refer me to go there. He gave me a one-time referral to a derm for an "assessment." I went this morning, feeling defeated before I walked in the door. But he was WONDERFULLY supportive! I knew I had P bad, but hearing him express disgust that my GP wouldn't let him treat me made me really see that it was as serious as I thought, and it wasn't overblown in my mind. (My last derm told me I should focus on my inner beauty and not be so vain!) I told the derm I really wanted to go to MOPC for treatment, and he said he would send me in a heartbeat if he could. He knows the staff and had nothing but positive things to say. He said I was a prime candidate for the "day spa." Even though he wasn't supposed to, he wrote me several scripts with lots of refills! I already dropped them off at the pharm, but I think they were Ultravate in two strengths, Elocon for my thinner skin, and a solution for my scalp. He is writing a letter to my GP to request that I be allowed to come back 4 times a week for light treatments. He told me if my GP refused, to call him and he would work something out with me (translation: $$$$). He was so great, I just might. He wants me to contact him in 6 weeks, regardless, to report if there is improvement. If not, he said he will contact my GP again and fight to start oral meds of some sort. He laughed when I told him he was the first man to see me nude in years! But, he made me feel better when he said he would fight to get me under control so I can pursue a normal life and a romantic relationship again—with confidence, not shame.

I was upset that my chance for remission is out of reach because of the idiotic insurance rules, and a lofty doctor that doesn't know how to treat me, but won't let me stray too far. So, say a little prayer that my GP wises up and lets me see a doctor who really WANTS to help me! But, I do feel like some baby steps towards remission were made today, and for this I am grateful.

Thanks for listening, and hopefully my next email will have some good news! -Lisa K.


Ed's Response: Reading your email made me grit my teeth, Lisa. I thought that HMOs were getting better. Have you any opportunity to migrate to another health plan?

Back in the early 1980s I went through a similar distressing set of circumstances but with heart problems. I belonged to an HMO and because of an emergency while out of town I ended up talking to an assortment of doctors who did not belong to (or in some cases cooperate with) my HMO. The experience was terrible, even though the HMO I belonged to at the time was one of the best-regarded in the country!

While embroiled in the subsequent who-covers-what battles at that time, a colleague made this observation: "I guess you know now why they call them health management organizations. They're not worth much when your health becomes unmanageable by them."

At least it sounds like you've found a sympathetic maverick of a derm, and that's great. Now that you belong to NPF, if the HMO is uncooperative (or unresponsive) you might find some support there, too. NPF has become expert at arguing with insurance companies and they may have some documentation or processes to help you. Don't hesitate to call them!

In the meantime, do keep us apprized! -Ed

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