Geneticist Vincent M. Riccardi, M.D., is a former physician credentialing officer and utilization review specialist for health care companies. Calif. Now claiming about 80 members, AMC helps patients negotiate with their health care companies to get needed services. Their health plan would not approve a pediatric surgeon. I offered to call the medical director, but the father said he wanted to handle it. The couple got their pediatric surgeon.
Doctors often leave out the phrase 'medically necessary' when requesting deviations from the plan.
Riccardi says he doesn't try to get his clients what they want, necessarily, but what they are ethically entitled to. He liked the third doctor, who was off the plan. The plan wanted to send him for a fourth consult, but he resisted. He went, he did, and he got the surgery from a plan doctor. The point is he had received good care and we told him so.