I hope this will be the last of our updates about our contracting situation with Group Health. This has been a three-year ordeal that I would not wish on my worst enemy. We had signed a contract with GH eleven months ago but it has taken them this long to implement it.
As of yesterday, March 25, 2014, we are contracted with Group Health. The one caveat with the contract is that we have not been contracted as their full HMO providers, but their PPO Networks. In the future the PPOs will become their majority products but for now many have the HMO product, which does not allow you to see anyone but a HMO provider, without prior authorization.
If you have an HMO product, you can ask your PCP for a prior authorization to see us. Prior to now, they have rarely granted prior authorization to see us and have required their HMO subscribers to seen intervention pain specialists or neurologists within their HMO, even if that neurologist has no personal interest or training in headache disorders. Regarding intervention pain specialists, while they are very good at what they do, there is rarely a place for their treatments in the most common disabling headache disorders. We offer compassionate and world-class treatment for the headache sufferer at a fraction of the cost of interventional pain procedures.
If the request of prior authorization is rejected, you and your PCP have the right to appeal the decision. If you PCP doesn’t want to appeal and you are motivated to get the care you deserve, you can delegate us to be your representative, even though you have never been our patient. We will then submit an appeal on your behalf.