Obtaining referrals for providers outside HMO networks

Last Modified: November 1, 2001

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Dear OncoLink "Ask the Experts,"
To what entity or person can I appeal that has higher authority to help press my case for psychological counseling as part of my cancer therapy? I thought somewhere that HMO's were obliged to go outside their list of providers if none of the providers could provide the services (my primary physician did make a formal referral). I had my mastectomy in April '96 and have been working on my own ever since, simply because my HMO won't move outside its list. Yet when I asked each person on the list whether he or she provided cancer counseling, they each referred me to the one person in my city who does this, and who, alas, is _not_ on the list. None wanted anything to do with me (too bad for them — I think I'd be a trip, but that's beside the point).  

We suggest you contact the psychologist in question to determine if they has any interest in attempting to negotiate a special rate for providing counseling services. You should simultaneously contact your employer's benefits office for assistance. There's no guarantee that the HMO will agree to such an arrangement. However, in some instances, they will make special arrangements for an individual patient. Finally, we suggest you also directly contact the HMO's Medical Director to discuss the situation.

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