Saturday, March 09, 2002

MORE MEDICAL FOLLIES. Perhaps my most blatant evidence that "fraud" is the default mode for HMOs.

Dear Member:

We are in receipt of a claim for services provided by Yasmin Panahy on 01/10/02. Under the HMO plan in which you have enrolled, specialist or hospital services are covered only if an electronic or written referral has been issued by your primary care physician prior to treatment, or if the services are necessitated by a medical emergency.

A review of your file shows that we have not received information with regard to a referral for these services. In addition, we have not received information indicating that these services were a result of a medical emergency. Unfortunately, as a result, we are unable to pay the claim at this time.

Care to guess the name of my primary-care physician?

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