I need some support in this decision

nancy324

nancy324

Cathlete
I see so many doctors each year, each one specializing in another part of my body. That's okay, but they're all so busy and overwhelmed and they don't talk to each other. This year my primary care physician forgot to order cholesterol tests and lost my urine specimen. I called to make an appointment for my annual mammogram in November, and the first appointment they had was in April. I saw my gyn about monthly back pain and she said she doesn't deal with back pain, even though the symptom only comes during PMS. It goes on. Granted, these are all minor annoyances, but what if something were actually wrong with me? And if you're not constantly pro active, you just fall through the cracks completely.

So, I found this doctor. She's an internist and specialist in women's health. She believes in a completely integrated approach to medicine. She believes in treating the whole instead of just parts. And she emphasizes wellness and preventative care. She's about 60 years old and is experienced in dealing with health issues of menopause. Her office is about a block from my office. Only one drawback: she doesn't participate in any insurance plan. So I'll no doubt be stuck with at least 50% of the bill, and probably more. Each office visit will cost hundreds of dollars. I will have to (GASP!) cut back on designer clothes and other luxuries. But I'll be 53 in March, and I think it's time, while I still have no serious problems, to establish a relationship with a doctor I can trust.

I think I want this for my peace of mind, but my DH, the cheapskate, probably isn't going to like it. I'm going to need some bucking up in order to approach him with it. Support? Do you think I'll be wasting my hard-earned money?
 
I think it is very important that you be comfortable with your doctor in all ways and it sounds like right now your care is very fragmented. I personally choose to only see one primary care doctor and I'm very comfortable with that decision. As for the cost, I'd say if you are willing to make adjustments to your budget to compensate, do it. When you talk to your husband, be very clear about your needs in a doctor and why this is important to you and tell him your plan for covering the costs. It's your body and you have a right to the best care possible for it.
 
Hi Nancy, I'm behind you 100%. With my kids and my mom I have been to countless specialty appointments. You are right when you say you have to be completely pro-active or you will fall through the cracks, your experience shows this with the forgotten lab orders and lost specimens.

You could put it to DH this way.... What is your most precious asset? Your health, of course. By continuing with your current health care situation you are setting yourself up for multiple unnecessary appointments because your issues aren't being addressed the first time (copays?), you are setting yourself up for a potential missed diagnosis of something major because nobody's really watching the store here, plus there is a price to pay for mental anguish and aggravation.

I think you should go with the holistic doc and rest easier at night.

Good luck!
 
I totally agree that your health is the most important thing. But aren't you a bit worried about her age? How much longer is she going to be practising?
 
Nancy,

I think the doctor you've found sounds terrific, and I also think it's smart to have one primary providing coordinating your care. So I'd vote for making the switch and paying the money! My only thought is, could you search around just to make sure there's not another internist who fits your needs *and* is covered by your insurance? It may be worth checking...though the doctor you've found does sound tailor-made for your needs! And, another thought -- maybe you'll end up with fewer office visits once you start working with a single physician, so the extra cost won't be as much as you think?

All good wishes,
Allison
 
Nancy,

Did she tell you WHY she does not participate in ANY insurance plans??? That seems odd to me and would send up a lot of red flags to me.

Therese
 
looking good said:
Nancy,

Did she tell you WHY she does not participate in ANY insurance plans??? That seems odd to me and would send up a lot of red flags to me.

Therese
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Thats what I was thinking. She sounds wonderful, but there is something wrong with a Dr that doesn't participate in ANY insurance plans. Have you tried doing a search on her for any discinplinary action? Or even just Healthgrades.com? Healthgrades costs a few bucks but it wil pull up all her certifications and degrees and any actions against her. Something seems out of sorts.

Nan
 
Actually that's not a red flag at all. Lots of providers are doing this these days. It's actually a bit more lucrative (s/p). It's a pain in the butt to file insurance and you make more money if you charge fee for service instead.

BTW Nancy, I think you should go for it. It's sad that people get lost in the cracks, but they do. You need a "go to" person regarding your health issues and it sounds like she is the one. The only concern I have is her age. How long will she be in practice???
 
spyrosmom said:
Thats what I was thinking. She sounds wonderful, but there is something wrong with a Dr that doesn't participate in ANY insurance plans. Have you tried doing a search on her for any discinplinary action? Or even just Healthgrades.com? Healthgrades costs a few bucks but it wil pull up all her certifications and degrees and any actions against her. Something seems out of sorts.

Nan
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It's not unheard of. In fact, I know some excellent docs who don't participate in insurance plans b/c of all the red tape, difficulties in helping patients have procedures covered, & the extra staff needed to deal w/all the related stuff.

Nancy, does your job offer only one insurance plan? We have an option of an HMO or PPO. The PPO costs more for scrips, but it's great when it comes to choosing docs & using out of network docs. Maybe you can see if there's alternative health insurance for you? It's SO important that you be able to see a doc you like & trust, I think you should just find a way to make it happen, & start shopping at Blue Fly instead of Bloomies. :)
 
Nance, I really don't have any real advice for you, I just wanted to give you a cyber hug and let you know that you're not alone in your frustration and worry.

As for the doctor you found, if you like her and you feel like she is on top of her game then go for it. I would take her age into consideration just because she may be retiring in 3 or 4 years and then you'll be right back where you started. I'm curious as to why she doesn't participate in any insurance plan. Have you sought recommendations from friends? I've been seeing a woman around my age -- she's an internist (I stopped going to a GYN after I went through menopause) and she just retired so I'm kind of in the same boat you're in. I'm not looking forward to finding a new doctor AT ALL. *SIGH*
 
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I think it is a great decision, Nancy!!! But as you know I am biased to a more integrative approach to health care.

Nothing aggrevates me more than the current approach to health care to treat a person as an accumulation of body parts. We are no cars for crying out loud where you take out a part, put in a new one and off we run again. It is a little more intricate than that.

I find it not surprising that the doctors you have been going to don't talk to each other.

My doctor had a similar approach to health care as your new one, everything was going through he and I LOVED it. Unfortunately she moved back to Michigan a few years ago because her Dad got very sick.

She didn't accept insurance either but the cost was much lower than I anticipated. Just be prepared that if she prescribes naturopathic remedies or vitamins, your insurance company will not cover it but since most of those remedies were almost cheaper than my co-pay on "regular" drugs it didn't make much of a difference to me.

To those who think it would throw up a red flag that a particular doctor doesn't accept insurance I understand their way of thinking but it is not the case, on the contrary.

These days, the ONLY ones benefitting from the health care crisis are insurance companies. They get to cherrypick their insured (or charge outrageous premiums) and get to tell your doctor how much to charge and how to treat you.
Now the way I see it, treatment decisions should be made between YOU and your doctor and not some bureaucrat at a health insurance who doesn't know you from Adam. In many cases though, doctors don't get to make the decisions anymore as to what is best for you, insurance companies decide what is best for THEM.

Doctor's fees are getting cut and we have moved from preventive care to in-out-symptom-here is a pill practice. Some doctors refuse to participate in being "regulated" by a bureaucrat instead of letting the doctor do their job and that's why they do not participate in insurance billing.

This is a little simplified and there is a lot more to this and health care but I will leave it at that and not step on my soap box.

Nancy, I think it will be well worth skipping a few designer clothes if you have a doctor that you can trust and knows the "whole" you, not just parts. Aside, by going to all those different doctors for different body parts, your co-pay adds up pretty quickly too, not to mention the time you are losing and always the chance that something could get missed due to lack of coordination or communication between doctors. I am a big fan of one-stop-shopping.
 
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Nancy,
It sounds like you've found a doctor that fits your needs perfectly, except for the non-insurance and her age.

For the insurance:
Does your work offer a flexible-spending program that allows you to put aside pre-tax dollars to pay for medical expenses not covered by insurance? It can save you a bit of money, because something like $150 dollars a month pre-tax comes out to more like $110 or therabouts after taxes.

As for her age, perhaps when she gets ready to retire, she can refer you to another doctor with a similar mind-set?
 
Believe it or not, some of the best doctors in NY don't participate in any insurance groups. I had a wonderful internist who stopped participating. In order to cover their costs, they have to see a patient like every 15 mins., and they don't get to spend the time they think is necessary. This doc liked to spend time discussing nutrition, etc., and wasn't able to do it, so he pulled out of the insurance network. These docs are generally good enough that people come to them anyway and pay through the nose. Which is what I'm contemplating. (ETA: Apparently Carola was posting this same idea when I was writing this!).

Yes, Laura, I'm in a PPO. I think the PPO pays about 45% of an out-of-network visit. So I will get something back. Currently, I have no co-pays for in-network doctors, but then I seem to get what I pay for. :mad:

ETA to Kathryn: Great idea, but the flexible spending decision is made in November, and we went for a bit less than usual this year. Most of it will be used for my DH's dental work. I should have had this idea a month ago. :confused:

Yup, Laura, Bluefly for sure. ;)
 
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Personally, I wouldn't worry about the age issue. A doctor who is in good health themselves (and personally I wouldn't want one who isn't) may practice well into their 70's and I've heard of some even older.
 
I am going through the same thing. I found a gyno who is pretty good though and orders blood tests for cholesterol, hormones, all that stuff. I had seen an internist that I hated! He scoffed at me when I talked to him about my periods...which come to find out, I have fibroids. So I say, pay the extra if you found someone you trust and can depend on for all of your health concerns. Its hard to find good doctors like that!
 
Nancy,

I certainly understand your frustration with the "bits and pieces" care we seem to get. I am so thankful that I have a great GP who really DOES look at my overall health and condition. In my area, there is an entire practice of what they call "executive drs" who do not participate in any insurance plan and it's not a red flag. Dealing with the insurance companies is a PITA for the drs just like it's a PITA for the rest of us and some opt not to deal with them at all. I think that we will see more and more of those drs that want to focus on care rather than paperwork. The only issue (and it's a big one, IMHO) is that of course this care is available only to those who can afford it and it limits the choice of physicians for the rest of us.

My other concern would be that you could need expensive testing or surgery and the cost could really get out of hand with no insurance. Even routine items like bloodwork would be costly since the listing you see on the insurance statement is a contracted amount and NOT what they would charge you if you weren't covered under a plan.

Hee hee I'm sounding like your DH the cheapskate! I prefer to call it "practical."

Maybe there is a way to integrate services with this dr. and other providers that would be covered?
 
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Medicine has become a business, and a poorly run one at that. If you find a good doc and are a relatively uncomplicated patient, hang on to him/her.
 
hiitdogs said:
Most providers for imaging, blood testing, surgeons, etc. participate in insurance programs and bill the insurance directly.
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That's what I was thinking or hoping. Is there a coverage issue with the tests being ordered by a non-participating physician or does that depend on the plan? Maybe it wouldn't matter with a PPO?

Nancy, we'll get you to the point with your DH that all questions will be answered! :D
 
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