Since your primary care doctor functions as the “gatekeeper”—blocking or granting access to specialists—choosing a good gatekeeper can be vital. You want someone who, if necessary, will appeal on your behalf if you need a special test or an extra day in the hospital. It’s often hard to tell much about a doctor from the brochures, so again, talk to other members, even people you bump into in the waiting room.
If you feel you’re being unjustly denied services you need, don’t be afraid to fight for them. If politely making your case to your doctor doesn’t work, try appealing to an administrator. All HMOs have formal grievance procedures.
Finally, the more you can learn about any medical conditions you have, the better position you’ll be in to assert yourself. HMO doctors have a difficult time saying no to reasonable, well-informed patients.
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