CBI wrote:
> "Magi D. Shepley" <[email protected]> wrote in
> message news:[email protected]...
>
>>Not for a new patient [that the wait is typically 9 days].
>>This isn't the first time this has happened,
>>either. It happened in my last state too: I picked a doctor, but when I
>>called, she only saw new patients 3 times per month, and didn't have any
>>appointments for 2 weeks. The fact that I had no voice, and a fever of
>>100 didn't make any difference. I was told to go to the ER. Which I'm
>>not wiling to do, as that isn't covered by my insurance and is just flat
>>out silly.
>
>
> I agree that it would not have been appropriate to go to the ER (and so
> agree with the insurer not paying for it). However, three months for a new
> patient, while certainly not unheard of, is also not the norm. I also don't
> think it is good practice and would say that the doc in question probably
> should just close to new patients until (s)he can better serve the current
> ones (since you know they also have quite a bit of a wait). It is reasonable
> to expect to be seen expediently so if the insurer does not want to pay for
> ER visits (or urgent care?) then it would be reasonable for you to ask them
> for help indentifying where you might obtain the care you are paying for.
My current insurance pays for urgent care/walk-in clinics. That was
where I went when I had pneumonia last year. That is a good resource
for some, but not for me since I frequently get bronchitis (from having
pneumonia a lot when I was little), and as I said, I need somebody
willing to work with a specialist. I need one general doctor, not a
rotating pick of whoever happens to be in the clinic at the time.
Given that this has now happened twice (the wait to find a new doctor)
in two states, and that in both states I have called multiple places, I
am guessing this is far more common than you think it is. Both places
were major metro areas, one very wealthy, and one city with a mix (my
area varying widely within a 5 mile radius). Most of the people that
live in the building that I rent are going to one of the two medical
schools for something: dentistry, pharmacology, nursing, pediatrics,
residency, interns, fellowships, etc. Both the medical schools near me
are very well known, and I guarentee that one of them is very well
respected.
The first time this happened, I wrote a letter to the insurance company
complaining about the issue... the insurance company sided with the
doctor and said that when I was first assigned to her I should have made
and paid for a "new patient appointment", and not waited until I got
sick. The second time this happened, I started calling as soon as I
moved to the area and had my insurance card... It didn't make any
difference. I still couldn't get a new patient appointment.
>
> Most practice management experts say that the current standard should be to
> try to get sick patients seen within a day or two (same day or next) and
> there are a number of scheduling schemes to help do this. The biggest
> barrier is that many docs, through years of poor mangement, have accrued a
> backlog that they would have to work through in order to catch up and
> implement them. FWIW my office offers to see all sick patients the same day
> provided they are not calling too close to closing (in which case they can
> be seen the next day).
That is what I'm used to. That was also what my primary care physician
in my last town (once I finally found her) did. If she were still on my
health plan, I probably would've stayed with her: she's only 45 miles
one way. I'm already driving 20-25 miles to the other doctor who isn't
as (IMO) good. But i'm staying with the other doctor because right now
I don't have time to go hunting yet another primary care doctor.
>
> Another hurdle, which I suspect is operative in your case, is that docs
> never really fully embraced the implications (as far as their
> responsibilities) of HMO's.
I suppose it would be if I'd had an HMO in either of these cases. I
didn't. I've had an HMO twice: Kaiser-Permanente and didn't have this
problem when I was with them... In fact, the one time that I really did
need to see a doctor because I had a significant fever (102), they were
willing to get me in at ANY of their nearby sites because the one I
normally went to wasn't available. They were willing to reimburse me
for travel to the site as well.
The other time was HealthGuard, and again, I never had this problem.
The last two times I've had PPO's where I get to choose who I want to
see and where. Obviously, if I stay "in network" with a doctor that
they already work with, I pay less... but its not an HMO.
Magi
