When medical experts advocate care, HMOs find it harder to deny treatment. Go to the administrator in charge of your doctor's medical practice and explain the need for the test or treatment. Request a written denial. Make sure your doctor documents your treatment and its necessity. Get a copy of your medical records.
Most states have regulations establishing such time frames.
Make sure you communicate clearly that you know the timeline and that it must be met. Get a patient advocate. When your health is at stake, you may have to resort to going outside the plan and paying for care directly. If the treatment is expensive and you're unable to pay for it, this may mean taking more drastic steps such as taking out a loan, getting a second mortgage, or asking for financial help from friends or relatives. Loren Stein, a journalist based in Palo Alto, Calif., specializes in health and legal issues.