How To Negotiate With Your Health Maintenance Organization (HMO)

How can I negotiate with my HMO?

If you get to the legal department of your health insurance company and there's a very ambiguous term, such as "medically necessary," and they're saying it's not, your doctor's saying it is; then you sometimes have a means to negotiate with them. And usually that's going to come best through an attorney, but they may offer you another alternative. They may offer you treatment at another care facility because they have a contract. So, you want to look at your procedure and, "Could I get this done at any other place?" You may also have to give up your first chosen place and go to another facility. So those type of things are depending on where your HMO has the contract. Sometimes you can get what you need, but you might need to go to a different facility because that's where the HMO has the contract. Those things sometimes are negotiable. The negotiation will not come, and will not take place with the person on the 1-800 line. The negotiation sometimes, and the flexibility sometimes, comes with the highest level person in the insurance company such as at the medical director level or the CEO.