Kaiser was the HMO that caused 3 patients to seek outside help. They were refused a paid outside second opinion on their thyroid problems.

1. 82 year old with rapid enlarging thyroid mass. The mass was growing and was causing pain, trouble swallowing. The primary M.D., ordered an Ultrasound, but it would be 6 weeks to get in to see the endocrinologist. She requested to see an outside consultant, but was turned down. She saw me, and paid out of pocket to get an answer to why she had the growing mass. One visit was all I needed to diagnose and start t he treatment. She still has not been reimbursed by Kaiser.
   
2. 5 year old Kaiser patient was refused the right to continue to see me as her thyroidologist, when she had to switch to an HMO. Without getting my records, which clearly stated she did not have thyroid cancer, they treated her with radio-iodine, after a whole body scan showed intense uptake consistent with a whole lobe left. They ablated a normal thyroid lobe, rendering her hypothyroid, when she did not have cancer.
   
3. 31 year old with 5 years of a very large goiter. Kaiser, and their endocrinologists refused to treat the mass, and even failed to use ultrasound to evaluate the large goiter. She requested outside paid consultation, but was refused. she saw me on her own dime, and in one visit, I diagnosed a MASSIVE CYST, by ultrasound. I drained 66 cc of brown fluid. Her cyst has not recurred.
   
4. Even though Kaiser allows their general surgeons to do the thyroid surgeries, they have no 50-150 case per year thyroid surgeons, they refused to pay for outside thyroid surgeon in several of my recent cancer patients seeking my opinion. They also refused to pay for my outside opinion.

What all have in common, is the lack of true access to specialists. They need to learn how to fight the system to get funding for outside help. Here are some tips to help you get the help you need if you are in Kaiser, or other HMO.

Here are some ideas to help you fight for your right to good thyroid care by a specialist.

Try www.insurancenightmare.com

Only 0.3 % of denial of outside specialist requests, are appealed! However, if you appeal there is a 42% chance your appeal will be honored.

What can you do?

1. Get past the 800-number customer service reps. They have been paid in the past to keep you away from the doctors, and are not health care professionals.
   
2. Ask for a case manager. They are usually nurses at least.
   
3. Tell them you have a complicated thyroid case, and that is why you need a case manager.
   
4. Write letters stating the serious thyroid condition is a threat to your health.
   
5. If you still fail to get results, ask for a review from the medical director.
   
6. If still are not satisfied, you can hire the Mary Jane Strull, the owner of the website to go to bat for you. She is a former claims adjuster for insurance companies. Your Bulldog!
   
7. Proper language helps your appeal. You can get help from Patients are Powerful. www.patientsarepowerful.org They have strongly worded letters requesting payment for outside specialist second opinions. They say "serious and imminent threat to my health." The The letter insists you get an answer to your appeal in 5 days.

Now come to see me or get a virtual second opinion, and have your HMO pay.