OBGYN and Insurance Question UPDATE @ #23

[SleepyatDVC]

I'm asking this here on the budget board because it is insurance and money related so I hope it belongs here.

I switched insurance plans about 2 years ago and my OBGYN does not participate. My primary doctor does participate. The cost savings was tremendous and I figured I was done having kids and didn't need to see my OBGYN anymore except for my annual checkups and it would be cheaper to just pay OOP for the annual check up visits.

I LOVE, LOVE, LOVE my OBGYN. I've seen her since my early 20's, so over 20 years, and went to her when I was pregnant with both my children. She's the only one I've ever seen. Even my Mom started seeing her for her check ups.

I haven't seen her in the 2 years I switched insurance plans. I haven't seen anyone else either though. I have a concern (just today) that I would like to check out soon though.

I "thought" the insurance broker told me that if I went to my old OBGYN and paid OOP for her out of network and there WAS a problem and I had to go for further tests, etc., everything would be counted as out of network and would not be covered at all.

I will try to call my insurance broker tomorrow to find out the full details though. Just trying to figure out my options. If my assumptions are right, if she finds something, can I THEN go to a covered OBGYN for follow-up and then have treatment covered? I'm thinking she will probably need tests done to figure out if there is a problem anyway and none of that will be covered. So, I should probably look for an in-network doctor now.

Do primary physicians do check ups for "woman" problems? Specifically, my breast. That might be a quicker option to finding a new OBGYN and getting an appointment as a new patient.

Thanks for any advice.

 

[tar heel]

Most primary physicians do. Mine does my annual physical, etc.

 

[fakereadhed]

Family practice docs generally do gyn care. Some internists offer this as well, but it is at their discretion. Most don't.

If it's something worrysome, you could go to your OB/Gyn OOP if it makes you more comfortable, then follow up with the new doc if it requires further treatment.

 

[SleepyatDVC]

Most primary physicians do. Mine does my annual physical, etc.

What about pap smears? That's not what I need to get checked out this time but the thought of my primary doing that... (shudder) Lol. I'm just use to a woman OBGYN.

But if the primary can check my breast, then I'll probably call tomorrow to schedule in appointment just in case. AND start shopping for a woman OBGYN for the other thing.

Thanks!

 

[SleepyatDVC]

Family practice docs generally do gyn care. Some internists offer this as well, but it is at their discretion. Most don't.

If it's something worrysome, you could go to your OB/Gyn OOP if it makes you more comfortable, then follow up with the new doc if it requires further treatment.

I think my primary doctor is actually an internist. But he has a female physicians assistant. I'll call and ask tomorrow. Even if not, I am way overdue for my annual physical (2-3 years) anyway.

 

[tar heel]

My primary is an internist, and she does my pap smears.

 

[prncess674]

I would call your OBGYN and say money is a concern and could she refer you to an in network OBGYN, rather than have your internest do an exam you are uncomfortable with. Have a list ready of local OBGYNs and be sure to let her know that your are preferably looking for a female doctor within X miles of her. Most doctors understand that insurance is a concern for most patients and will gladly give you a name of a doctor they trust.

 

[bridget]

A lot of primary care doctors (general practitioners, internists) will do annual female check-ups. Also, many have nurse practitioners that will. Plus, I know you can get in to see the nurse practitioner much sooner, many times. I see a nurse practioner in an OBGYN office and she is the best. She saved my life

That would be terrible if you found out you needed more tests and it was all considered out of pocket

I thinking calling your primary tomorrow and scheduling an appointment sounds like the best plan and not delay.

 

[WildabouttheMouse]

I work in a hospital, and I can tell you do not wait. Go to your PCP and they will give you a script for a mamogram and if necessary a breast ultrasound. If there is a problem then you can get a list of in-network GYN's to follow up with. But delaying can end up costing you more. Good luck and take care of yourself.

 

[ToodlesRN]

You could see your ob/gyn and pay oop and then if she suggest further testing have her tell you what she wants and then go see your primary and have them run those test that way a portion will be paid for with your insurance. Be an adcovate for yourself and play the get around your insurance game!! Working in a hospital I see people do this all time.

 

[miralys]

I would call your OBGYN and explain that you are looking for a referral because they do not participate in your health plan and you need an annual checkup. I am sure they get those requests all the time. Whatever you decide to do, don't delay!

 

[Meshell2002]

I'm a trained FNP. I would go to your PCP, get it checked out (you referred to your breast) initially and then if anything is "not normal" they will order any inital tests (mammogram, ultrasound) you need and refer you to a covered specialist (sometimes for a breast issue its a surgeon for a biopsy) for follow up.

 

[ceecee]

I would call your OBGYN and explain that you are looking for a referral because they do not participate in your health plan and you need an annual checkup. I am sure they get those requests all the time. Whatever you decide to do, don't delay!

 

[mhsjax]

I want to offer this, unless things have changed since I did insurance, and I worked for an OB/GYN. If you payed for her OOP, but she referred you to someone for further tests, like x-rays, mammograms or ultrasounds and they are participating in you insurance, these should be covered regardless of who sent you there. I would call your Insurance company and get clarification of this.

And yes, OB/GYNs are very sensitive to patients and wanting recommendations for other Drs due to insurance changes. I am sure she can and will give you her top choices for a new Dr, if you decide to go that way.

Also keep in mind that OB/GYN's can be very hard to get into, and being a new patient it will take you longer than if you where going back to en established Dr/Patient relationship. Unless you get extremely lucky. New patient appts take much more time.

 

[Jaime4004]

I'm a trained FNP. I would go to your PCP, get it checked out (you referred to your breast) initially and then if anything is "not normal" they will order any inital tests (mammogram, ultrasound) you need and refer you to a covered specialist (sometimes for a breast issue its a surgeon for a biopsy) for follow up.

The OBGYN wouldn't do anything different, i'd save your money and see your PCP. I'm an FNP also and never worked with an internist who didn't do women's care also. Ordered mammogram/ultrasounds all the time..

 

[HM]

I gave up my OBGYN after I stopped having kids. I only see a Family Physician. They can see you for all things. Just go to him/her since you are covered.

 

[Pakey]

Call your primary. When I found my lump in my breast, I waited 2 months to get into my GYN. I could have seen my primary in 2 days. I ended up with the same tests (mammo, ultrasound, biopsy) that I would have gotten with my primary, only I had to wait longer. Once the biopsy came back positive, I was referred to a surgeon and an oncologist and it didn't matter at all whether I'd started with my primary or the GYN.

 

[SleepyatDVC]

Thank you all for the advice. This is absolutely the best place to ask anything!

I called my primary doctor. His female PA actually was the one to answer the phone (instead of one of his 2 receptionists). She's squeezing me in tomorrow morning to have my breast checked out and told me I can make my appointment for my regular check up when I am there tomorrow.

Hopefully, it is nothing. It was really sore and more painful last night but better today. But since I'm over due for my mammogram and wellness check ups anyway, better safe than sorry.

 

[rentayenta]

OP, if you can prove continuity of care with your ins co, they will pay an in network rate for your OBGYN. It's work but worth it if you feel strongly about keeping the same one. The only issue would be the fact that you missed your annual.

 

[disfan07]

OP, if you can prove continuity of care with your ins co, they will pay an in network rate for your OBGYN. It's work but worth it if you feel strongly about keeping the same one. The only issue would be the fact that you missed your annual.

Not necessarily. We tried this for one of my specialists when we switched insurance and they would not cover her in-network. Only out of network so we ended up having to switch providers. Ended up not being too bad since I actually found a doctor that is 10 times better than my previous doc. And I had never missed an appointment so that was not an issue.

But the insurance company didn't give a hoot about continuity of care. They said that since there were other options in network we had to choose someone in network. And we have a PPO with a lot of flexibility and they didn't care.