11/23/2009: Let's face it when Texas Department of Human Services contracted HMO's to do their job it all went to shit! I live in Conroe, Texas (Montgomery County) and when I moved away 7 years ago to live the country life TDHS still handled these things. The way things worked is that you had a provider service such as Texas Home Health to name one, and when you needed things such as wheelchairs, or equipment (DME - Durable Medical Equipment) you asked your doctor for a prescription for it to be faxed to your home health agency, they in turn put in a bid to TDHS and they had 14 days to respond with an approval or denial which you could and should appeal. After this approval most times the agency such as Texas Home Health made the order for your equipment and about 2 weeks to a month later it arrived at your house. Pretty simple right? As with anything that works...let's change it!!

Now you have HMO's such as AmeriGroup, Molina, and EverCare to name a few. Now I'll tell you how it works.

1) You call your case manager at your HMO and usually get a recording or someone tells you they are on vacation or out to lunch (at 2 or 3 in the afternoon?!).

    a) You leave a message and they call you back in a week and ask what you need like they didn't listen to the recording.

2) You tell them you need something like a wheelchair, bath bench, vehicle mods, or whatever you need and they tell you to get a doctor's prescription and fax it to the DME they choose to use. You then wait a week and call back to check progress and they get rude as hell with you and say they never got the order from your doctor. Repeat step 2! After they get the orders they are supposed to present a bid to your HMO for approval or denial. This may take a month. If it is approved the HMO approves and the items get ordered at your DME's convenience, not yours. About a month later you will get the items. STOP!! This is if you are very lucky because like most insurance companies they originally deny the request and send you a letter you must respond to in 10 days or your request is considered void. I have had to appeal more than a few times to get what I needed and what as many as 3 doctors told them I required. Remember don't give up - appeal as many times as necessary and you'll usually get it then. I have waited as much as 6 months from the time I asked for something till it was delivered.