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View Full Version : Even more frustration with doctors!



magistramarla
02-17-2011, 04:36 PM
You know how frustrated I am with my rheumy not even checking my liver function while I'm taking MTX.
Well, I called to get an appointment with BonusMom's great Sjogren's specialist in San Francisco. It was going great with the sweet young man who answered the phone, until we got to the insurance part. Dr. C is not on my insurance network, so there went that great idea.

After I calmed down a bit, I thought about the fact that UCSF IS on my insurance network - that is where I go for my Spasmodic Dysphonia treatments and where Jeff goes for his specialist. I researched the rheumatology department there, and I was very impressed. It is staffed with several Lupus experts and people who are doing some good research about lots of AI diseases.

I spent a long, long time on hold two days in a row trying to reach the rheumatology clinic. When I finally got through, I was told that I could NOT get an appointment there without a referral from my current doctor! I don't think that it is very likely that my rheumy will do that. I'm also reluctant to ask the PCP, since he's the guy that told me "You might be a hypochondriac."

I'm now totally frustrated. I'm thinking that I should just suffer through with the minimal care that I'm getting until we move back to San Antonio in 2012. My PCP and the great rheumy that I have there will be quite interested to hear this story. It is so very frustrating to know that there are experts that probably could give me the right treatment just 100 miles away, but I can't get to them. This is a terrible medical system for those of us with weird diseases!

OK, so that was my vent for the day!
Hugs to all,
Marla

Nonna
02-17-2011, 05:47 PM
Could the referral be give by the doctor you see for Spasmodic Dysphonia? I hate the thought of you going through this for a year

jmail
02-17-2011, 06:04 PM
... It was going great with the sweet young man who answered the phone, until we got to the insurance part. Dr. C is not on my insurance network, so there went that great idea...
Can you pay cash, maybe even getting a discount for that, and then submit the expenses yourself to your insurance carrier? If I go "out of network" on my insurance, then they cover 70% (usually at least 80%+ for "in network). If I have the doctor's office file the paperwork, I get charged a "usual" fee. What I've done a few times is pay for the visit up front, and then submit the expense. The one doctor's office charged me $60 instead of the "usual" $85. They said it was because they have the money right away, and don't have to go thru the expense of using my insurance. After getting the 70% back from insurance, I "paid" $18. If I'd done an "in network" doc, I'd pay $17... hmmm

BonusMom
02-17-2011, 08:27 PM
Marla, Dr C isn't contracted with any insurance companies. She doesn't want an insurance company dictating how she should practice medicine.

My health insurance pays her at the non-contracted rate. The OV is 225 and my carrier reimburses me an estimated 90, give or take (understand why I only see her 3-4 times per year?). I know it adds up, but because I save elsewhere on costs, I "splurge" on this because I'm worth it (wasn't that a commercial back in the day?).

Seriously, I wouldn't pay that kind of money for a 10 minute OV, but I get as much time as I need (45-60 mins average) and she does follow up phone consults at no charge.

I think your present rheumy is a danger to your health. Please talk it over with Jeff and see if you can work something out. You won't be sorry.

kim,l
02-17-2011, 09:20 PM
dear marla i am sorry about what you are going through i think it is terrible you would have to wait a year and how dare that doctor accuse you of being hypochondriac i know how that feels i have had same treatment your system really stinks i hope you can sort something out i wish i could be there to give you are hug in person but i am sending you one many hugs kim l