When Your Medical Group Won’t Provide What You Need

Having trouble getting the medical care you need?

Health-maintenance organizations and insurance companies typically get the blame for delaying or denying visits to specialists and other types of care. Increasingly, though, the rejections are coming from the medical group with which your doctor is affiliated.

And now that some medical groups face financial problems, the situation could get even trickier for consumers. If you require expensive treatment, the firms could drag their feet in hopes that “maybe you’ll decide to change medical groups and get off their tab,” said Peter Lee, a consumer advocate with the Center for Health Care Rights in Los Angeles.

Often the problem can be resolved by contacting the medical group’s customer service representative. In case that doesn’t work, here are some other tips:

* If you have an urgent problem, particularly if you believe the medical group is delaying care because of its financial difficulties, contact the California Department of Corporations. As the state’s recent takeover of MedPartners Provider Network Inc. demonstrates, medical group solvency “is something they’re very attentive to,” Lee said. Call the department at (800) 400-0815. Or you can obtain a complaint form at https://www.corp.ca.gov.

* Talk things over with your doctor--in most cases, this is the first thing you should do. If you get the doctor on your side, you have a much better chance of persuading the medical group to approve the treatment you want. If your doctor is unsympathetic, try getting a second opinion or choose another doctor as soon as possible. Also, you might be taken more seriously if you put your request to your doctor or medical group in writing.

* Talk to your HMO or insurance company. If talking to your doctor or medical group doesn’t work, the HMO or insurer might be able to intervene. The medical group, after all, commonly is a subcontractor to the HMO or insurer.

* If all else fails, try to enlist the help of a consumer advocacy group representing patients with your type of health issue. For example, cancer patients can try the Cancer Legal Resource Center at (213) 736-1455. People with disabilities can try the Western Law Center for Disability Rights at (213) 736-1031. In addition, low-income consumers can request help from the Health Consumer Center of Los Angeles at (800) 896-3203 or the Orange County Health Consumer Action Center at (800) 834-5001.