HMO out of group referrals

[ial]

I am having a problem with my Koch pouch (leakage etc.) and there is no doctor in my HMO group that can handle it. I am being referred to Dr. Worsey at Scripps which I am pleased about but everything takes so long. I cannot make an appointment at Scripps until there is a letter of agreement. They also inform me that I will need a pouchoscopy (which makes sense) but I am only being approved for a consultation. The original surgeon's office I saw said they do not do a referral for the pouchoscopy and it will need to be done by Scripps. This will mean an almost pointless visit for a consultation and then waiting for another letter of agreement. I am fairly certain that the valve has failed and I will need surgery which will need to another wait. Has anybody had experience with dealing with this and suggestions to get things moving and cut through the red tape. I will be changing insurance on August 1 as I will be under Medicare. I will be using the same doctor's group but if this drags on, I don't know if it will put me back to square one. It has already been over two months since my GP did the initial referral to the in-group surgeon. Any suggestions would be much appreciated.

Thank you, Iris

[squid56]

Iris, what has tended to work for me is to talk to the powers that be and explain what is going on. Basically tell them that you are leaking and what you are leaking, and ask them how they would feel if it was happening to them. Then ask them how they would go about getting someone to act on it so that the problem can be fixed. Usually when you get graphic and ask them to put themselves in your place it can help. Good luck!