Quote:
Originally Posted by BigDawgInLakeDenham
Why are you all so worried about specialists? Why aren't you worried about a solid primary Care doctor that can get to know you and manage your needs? Are you those people that don't have a doctor but want a specialist when you're really f'ed up? I'm really interested in how you come up with your way of thinking because I spent a career working with people coming into the hospital because they believed themselves to be healthy and would see a specialist if they ever needed, but because they didn't pursue primary care, like managed care or an advantage plan, they were too far gone for any "specialist" to save. The general public knows nothing about navigating the Healthcare system. I had an HMO for 40 years of work and have always had everything I've needed because you can get "specialists" and I get all of the same in my "mistake" of an Advantage Plan. You never admit that you can choose a PPO that gives you more doctors to choose from or do you not understand that concept. Please do tell us your health history and how it's negatively been impacted by Advantage Plans and how traditional Medicare has saved your lives. Never once was I told not to do CPR on someone because they had an advantage plan. Never once did I not do labs on an advantage plan patient. Healthcare Professionals don't see insurance in that moment you really need them. Actually I never heard anyone mention a patient's insurance. Other people's health and lives is nothing to tinker with and insurance choices are and should be personal. Everyone needs a Primary Care Physician to manage their care and to recommend appropriate treatment including a specialist, only if necessary. Seeing a specialist unnecessarily is abusing and burdening the health care system but entitled people don't see it that way. I'm done for now
|
It's not about that. When you go to your regular physician for a problem, and the physician says you need a specialist, you need to know if you can afford to go to the specialist. Knowing whether your insurance covers specialists in your area, especially if your regular physician refers you to a specific one or group - is incredibly important.
Getting a PCP is a no-brainer. There are dozens and dozens of them, and you just have to pick one that accepts your insurance. There aren't dozens and dozens of specialists in each specialty, and many of them don't accept medicare at all.
For instance - I know I need a hip replacement. My PCP doesn't do those. I need a specialist for that. So when it was time for me to select my health insurance plan, I had to consider the cost of the hip replacement in mind. They run around $25,000 for people who don't have any insurance and aren't in a poverty level to get a break on the price. My insurance has super low premiums - only $17/month. No deductible. But an out of pocket expense max of $9700. That means - if I need a hip replacement THIS year, I'll pay $9700, instead of $25,000, and other medical expenses for the year won't cost anything at all.
If I don't need the hip replacement this year, then I'll pay my co-pays throughout the year when I go to the doctor, UNTIL I've paid out $9700, and then I'll pay no more til next year. Right now I'm racking up $85/DAY in expenses because I'm undergoing radiation treatments for skin cancer. My PCP doesn't provide that service, a specialist is handling that. That's the co-pay for specialist services on my plan.
I'm not on medicare yet, not old enough yet. But the explanation of "why" people are concerned about specialist access is the same no matter which type of health insurance you have.