I had finished radiation in December of 2005, by late March I was having some difficulty with a few teeth that were in my field of radiation, then in early april a piece of bone began to protrude through my gum. My oral surgeon set me up with an appointment with the nearest hospital that does HBO treatments, that was Millard Fillmore in Buffalo, the problem is that I live in Rochester which is about 70 miles away. Now my insurance says that since it is out of there service area that I must pay a $250.00 deductible and 20% of the cost of treatments, on top of the 30-40 daily commutes on a toll highway with $3.10 a gallon. It just really pisses me off that if there was a local facility that offered HBO treatments I would be covered, so in essence I will be finacially punished for where I live. This is an insult on top of the $100.00 a week just to commute for treatments. Is there any way around this? How much do HBO treatments cost? This damn illness just keeps finding ways to make you pay.

Lenny, when I ran into an Ins. issue much like yours, I did 2 things: #1, I filed a written appeal to the Ins. Co., explaining that the needed treatment was Physician prescribed and was not available in our network and that necessitated going where it was available: #2. At the same time I filed a complaint AGAINST the Ins. Co. with our State Ins. Commission to the issue. Our State commission then wrote the Ins. Co. and within a matter of 2 months, our claims were paid in full. It takes energy to fight the Ins. guys, but it is worth the effort. Good luck. Amy

Lenny, the foregoing is excellent advice. I have an insurance background and know that contacting the regulatory authorities can have a dramatic effect. Go here for contact info for your State Insurance Department:

http://www.ins.state.ny.us/hpoffnos.htm

When you contact them, be very to the point and factual. It is sometimes easier to outline your concerns as bullet points.

When you write to your reluctant insuror, be sure to include a cc: notation to the New York State Insurance Department. Then enclose a copy of that letter when you write to the Department. This will put everyone on the same page. Do not use e-mail or phone calls. You want this to be very serious, and in hard copy form. Finally, check spelling and grammar -- twice. Have someone else proofread your letters. This sounds a bit obsessive, but the better you present yourself on paper, the better response you will get.

Now go get em'!

Additional information.

It looks like you can send your letter to the Albany, Buffalo, or Long Island addresses, all of which have Consumer Affairs Departments.

Dear Joanna and Amy,
Thanks so much for your input. Joanna thanks for that insurance info, that is invaluable to anyone who may come across an insurance snafu. Your advice about spelling etc. is so right on, Joanna you are speaking to the choir, I teach High school and have been preaching that message for years about getting someone to take you serious. I do have good news the Insurance co. relented after I made a call to the patient advocay supervisor and my GP doctor fired of an angry letter and threatened to inform the very board you spoke of and like magic I was approved. I will be starting treatments in a few days so thanks so much for your expertise and advice.
always lenny

Lenny, That's about the length of trip I'd have to make to get HBO (the nearest place is Syracuse). I'm glad you got the insurance company to relent. Do you mind if I ask what carrier you have? It isn't BC/BS excellus of Central NY, is it (hope not, that's who I have)?

O.K. Lenny, talk about "preaching to the choir" I'm an older English teacher, and I need to correct one of your sentences. i.e. It should read "getting someone to take you SERIOUSLY"
So glad to hear that you got your ins. issue handled! Yeah! Best luck with the HBO treatments. Amy

That's great, Lenny! With apologies to Amy, you done good (grin).

Joanna, No need to apologize- I hear that everyday in our Ozarks hills Amy

AMY,
I stand corrected, it would not be the first time,however History, Government and Politics are where I attempt to excell. I am a socialist at heart.

Nellie I have Blue Cross-Blue Shield-Blue Point2 extended.
and to all thanks for all of your support, I start HBO treatments thursday morning, they want me there by 7:30am and it is 70 miles away, arghhhh.
I love my friends here, just don't know what i would do without all of you.
Thanks a million,
Lenny