Changing Docs because of Insurance...

[JoiseyMom]

I know I should be happy that I will no longer have to deal with COBRA...but our current Primary doctor isn't on our new insurance plan. He has been me and DH's doctor for 15 years (well mine), he has been DH's longer.

I am thinking of just picking any primary care, and just using him and paying OOP if necessary... I hate having to start over with a doctor that has no idea who I am or anything. THis current doctor even sees in laws and knows the entire family history, which we think is really important.

I really really hate these insurance companies and the way we have to jump through hoops for our basic health care!

I am having the same issue with our dentist. He is great wth our DS, so I think we will pay out of network since I don't want to switch him too.

Thankfully our pediatrician and my gyn is on the list.

Sigh... Ok..time to randomly pick some doctors name .

 

[sbell111]

Maintaining a provider network is important to reducing health care costs. Obviously, the insurance company cannot simply agree to pay any old doctor whatever he/she charges. Plus, the insurance company would not be able to ensure that quality of care be maintained, since these random doctors wouldn't be 'credentialed' by the company.

Why don't you ask you current doctor if he can recommend any of teh contracted doctors?

 

[Piecey]

I had to switch, too. I have two forms of insurance and my doctor I've had since I was 16 is a PPO provider on my secondary, but not my primary. It was a mess when I went once, figuring since they were PPO on the secondary that it would work out but it didn't.

I just gave up and haven't been to a doctor other than my OB, who thankfully is a PPO provider on both!

 

[PatsMom]

One potential problem with seeing your current primary care and paying out of pocket would be if you needed a referral to a specialist. The network of doctors your current PCP works with might not be the same as your new insurance company's network. This would mean if your current PCP said you needed a specialist you would have to see in in network PCP and get his or her approval for a referral.

Might be just as easy to locate a good doctor and start over.

 

[hiwaygal]

Have you asked your current provider if he would consider becoming part of your insurance companies preferred providers?

When my doc of 5 years wasn't on my insurance company's list of PPO's, I sent my doc a letter explaining why I felt it was in my best interest to stay in his care.

Don't know if I got lucky or what, but my doc was listed as a preferred provider by the time I needed him to be.

 

[Kirby]

Have you asked your current provider if he would consider becoming part of your insurance companies preferred providers?

When my doc of 5 years wasn't on my insurance company's list of PPO's, I sent my doc a letter explaining why I felt it was in my best interest to stay in his care.

I would definately try this. I was getting ready to ask the same thing and Denise beat me to it.

 

[Pakey]

Have you asked your current provider if he would consider becoming part of your insurance companies preferred providers?

When my doc of 5 years wasn't on my insurance company's list of PPO's, I sent my doc a letter explaining why I felt it was in my best interest to stay in his care.

Don't know if I got lucky or what, but my doc was listed as a preferred provider by the time I needed him to be.

I agree with this. When our company changed plans, all of the employees brought in their list of primaries and we were able to get most of the doctors to become a provider on our new plan.

 

[JoiseyMom]

Maintaining a provider network is important to reducing health care costs. Obviously, the insurance company cannot simply agree to pay any old doctor whatever he/she charges. Plus, the insurance company would not be able to ensure that quality of care be maintained, since these random doctors wouldn't be 'credentialed' by the company.

Why don't you ask you current doctor if he can recommend any of teh contracted doctors?

If that were only true. My doctor is accredited by the company. He only participates in the plans that pay him enough to cover his high costs. Our insurance company, like most others have lots of different plans under them. Not all docs take all plans.

You really think the big insurance companies want to lower health costs?? All they want to do is deny coverage and pad their profits and bonuses.

 

[JoiseyMom]

One potential problem with seeing your current primary care and paying out of pocket would be if you needed a referral to a specialist. The network of doctors your current PCP works with might not be the same as your new insurance company's network. This would mean if your current PCP said you needed a specialist you would have to see in in network PCP and get his or her approval for a referral.

Might be just as easy to locate a good doctor and start over.

Well I have considered that. If I just had a sore throat and knew I wouldn't need a referral (ick I hate them and haven't had an insurance that used them in years!!) I would go to my old doc. If I wasn't; sure what was wrong with me and knew I needed a referral i would go to the Primary.

It is hard finding going to a new doctor though. Like I said..I am sooooo happy my gyn is in network. That change woulda killed me!

 

[JoiseyMom]

Have you asked your current provider if he would consider becoming part of your insurance companies preferred providers?

When my doc of 5 years wasn't on my insurance company's list of PPO's, I sent my doc a letter explaining why I felt it was in my best interest to stay in his care.

Don't know if I got lucky or what, but my doc was listed as a preferred provider by the time I needed him to be.

I have already spoken to his office, and he isn't going to switch just for us. It isn't financially feasable. I now have to go and get copies of our records.

He is a wonderful doctor and a great diagnostician.

 

[lovetoscrap]

Have you asked your doctor if he can recommend someone on the list that is covered? When we had to leave our PCP that we loved because of insurance we talked to him and he recommened a guy right across the hall that he knew and respected.

We hated changing but it was easier knowing that our Doctor liked the guy and we also knew that the new Doc would check in with the old one if needed. Sure beats going "einey, meany, miney, moe" with a list of names.

Fortunately our company switched plans the next year and we were able to switch back.

 

[cheerful chickadee]

That's happened to me also, my DH's employer switched from using a PPO to a POS (I know what they are but have no idea what the difference is or why the change) and none of my docs are covered, not my OB/GYN or my primary. I've been a patient of my PCP for 20 years! Ugh, I don't want to start over! I still haven't found a new PCP, all the reccomended ones are not taking new patients. I can't find a OB/GYN that's closer than a 40 minute drive from my house I hate that we pay so much for this insurance that we hate but my DD's pediatrician is covered and that is more important

 

[lsyorke]

While paying out of pocket sounds like a good idea it can be a big problem if you get admitted to a hospital and have no doc on record for your coverage. A primary doc will need to have your history if you require hospitalization.
Our plan also doesn't pay for lab work or testing ordered by an out of network doc.

I have paid out of pocket on occasion for a second opinion, but we keep the in-network doc for normal visits.

 

[Kirby]

Maybe ask a friend if their doctor is on your list.

 

[golfgal]

Our plan has 70% coverage for out of network providers, compared to 100% for in-network. Check into the details of your plan to see if you have any coverage. It can get very expensive to do that however. It stinks to have to change dr's, especially your primary care dr. My ENT was not on our new plan but since I only see him once/year it was ok.