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“It doesn’t matter what your card says. We’re not taking patients.” Or the Joys of Obamacare, Part 320,349
Today, I finally decided I was low enough on my standard medications for my chronic illnesses that I would finally contact that new doctor I signed up for in August. It didn’t take effect until September 1st. See, I had to fire my last internist. After a (literal) 5 minute appointment with the man for my yearly evaluation, I was told that he was very busy, one of my other specialists could do my labs and investigate any further issues (that being every issue, since he did nothing). That was the extent of the appointment. After he rushed out, I was nearly in tears which does take quite a lot for me these days.
I fired him when I got home.
Today, I called the new office to make an appointment and was told that New! Improved! Not Crappy! Doctor could not see me as she was no longer taking patients. I said this had to be in error since she was still listed on the insurance website as taking patients. We’re in open enrollment, so surely this was a miscommunication. Even if she was no longer taking patients, I had her assigned as PCP in starting in September. I’m not “new” exactly, I’ve just yet to see her.
I was told after a long hold that it didn’t matter what my card said. She’s not taking patients. After a dead silence and absolute shock, I mentioned that this sucked and she murmured something resembling a non-committal sound of questionable agreement with the sentiment. I asked if any other doctors in the office were taking patients. One. One that I know for a fact has gone “boutique”, which is to say, requiring a yearly down payment prior to any appointments. That same doctor (who is excellent, I might add), is booked up through February.
I hung up, completely flattened.
I’m now on the phone with my insurance discussing complaint filing, but basically being told to just look through their catalogue and pick. I have a migraine. I’m about to run out of medicine and my only recourse since the advent of Obamacare is an urgent care or the ER. I am in tears because it is not going to get better. I finally hung up because the front staff of the Place I Wanted to Go has switched phones to voicemail over an hour early and cannot be contacted by my insurance carrier. All medical offices will be closing soon and there’s no point in picking people from a list and then calling them one by one to ensure they will take new patients (which is the only consolation my insurance has offered me). Come January 1st, my insurance goes from HMO to even crappier HMO.
I have chronic illnesses that are already impacting my life. It is hard not to embrace California’s Right to Die law while sitting here knowing that my quality of life will be stolen from me, not by the disease process; but by sheer incompetence, reduced access to timely care, and legislated medical malpractice.
Published in Healthcare
This sounds like a complete failure on the part of your health plan. Even more shocking that you say it is an HMO plan. I can guarantee you they have several people on staff whose job it is to identify chronically ill patients like yourself and make sure you establish a relationship with a PCP. As you said in a follow up comment, you are a prime candidate to incur an otherwise completely avoidable hospital admission.
Just a shot in the dark here, but search your health plan’s website for some kind of information on care/case/disease management programs. They probably have nurses on call whose job it is to find patients like yourself. If you can reach them first, I bet they’d be more than happy to help find a PCP that works for you.
Perhaps even the preferred in the eyes of the carrier and federal/state government.
Perhaps, merely thinking out loud.
It’s interesting: almost like all of the small and medium sized medical practices are putting on an updated performance of Lysistrata.
“Sorry, but we can’t help you if you’re using Obamacare. Maybe things will get better if it goes away…”
I am SO lucky. I’m covered under hubby’s employer-provided plan (Union employee). My personal physician, sole practitioner, has a “membership” practice. I pay $100 a month, and I get email access, near-instant appointments, nurse who will make house calls if necessary, all the time I need for office visits. I pay for all my own generic medications, so my doctors can write for multiples of 100 and it makes the Costco pharmacy’s job much easier. I can see my specialist every 6 months no problem, and I get my lab results, online within 24 hours (which I still consider a minor miracle).
My own employer has two plans, high-deductible and higher-deductible. I was very surprised that the premiums will not be changing next year for employees who have one of their plans. Wonders never cease.
The chocolate ration has been increased from 30 grams to 25!
Obamacare is obviously a car wreck from coast to coast, but are there California regulations that make it even worse there?
you know….it’s the damn robots…..You have a problem with your insurance.. you call the company and they put you on hold….what they have done is put everyone in a great blender…where our needs and wants and wants for our families are all the same….and so they can put each of us on hold….without guilt….without caring……that is what government health care is… Think if you substituded. all those robovoices with the voice of a paid, and proudly employed, human….I know I’m a dreamer…but I am not the only one…..
The glorious socialist revolution continues apace!
In Soviet America, the doctor makes you sick.
@MBF suggestion to ask your insurance for a complex case manager is an excellent idea. And may actually give you a voice on the insurance side, and an actual person you can dial direct.
The problem your describing is used to be referred to as “ghost networks” and refers to providers listed as members of insurance networks or HMOs that are not accepting new patients, or are no longer with the networks. In the world of behavioral health, it’s been a problem forever and there have been lawsuits over it (pre-Obamacare).
Damn. My needed meds are controlled. :(
That is similar to the boutique or “concierge” plans we have in SoCal.
This is a great idea. It works very well for a large number of chronic health issues. Frankly, insurance hates me. Anything to keep me away from spending money and using their resources.
I will look into it further. I’m already identified in a high stress group and migraine group. These both have a nurse manager who checks in from time to time to see if you are managing your wellness.
I hear you! I had an Obamacare HMO in 2015 that came very close to killing me. It was just a kidney stone and after 8 procedures, a nephrostomy bag for 4 months, and a close call with renal failure, I was allowed to go to a real hospital. The kidney stone was removed in a 2 hours after my plan had already paid $250,000.
In 2016, I joined an Ocare PPO which was great except for the RX plan. I pay $1200/mo. for the PPO (just me). I take 3 upper tier meds and these cost $250 per month, per Rx. I ordered my migraine Rx (STILL not a generic after 13 years) from Canada because I can’t mess around with it, turns out I was dealing with a Turkish company. It works so I don’t care if it’s a placebo or even something that would end my misery.
This year we have the choice of only 1 insurer with NO PPOs. The cost of the HMO plan I had is going up to $1,678/mo. We can’t afford this. Plus I’m trying to change PCPs, having the same experience and none that I called will take even a Gold or Platinum HMO.
I’m trying to keep my fear and anxiety from my husband who has Early Onset Alzheimer’s but, of course he senses that I’m a mess. Who will care for him if I’m not healthy?
I go down to Algodones, Mex. for my dental work every so often (there are 100’s of dentists there) There are lots of pharmacies there and I usually pick up my meds for less than the co pay here in CA. I’ve met people from all over the US and Canada there taking advantage of low dental and meds.
The don’t have every thing but it might be worth checking out. Lots of people do. Dental work is a fraction of what you have to pay here. This is the start of there busy season. You don’t have to drive into Mex just park in a huge lot and walk across the border, every thing is within a few blocks.
I couldn’t get an appointment to see A-hole doctor for a 6 month period. Many of my meds, the doctors will insist on an appointment before refill (gotta get paid). It took almost two months because, frankly, I’ve been sick. I’m either working or sleeping with the occasional period of insomnia.
It’s been a full time job. On my days off (after 3 12.5 hr shifts in a row), I take care of my daughter and sleep. I sleep, commonly, for 16 to 18 hours. It makes it difficult when intermittently bedridden. The other times I tried to call, I was stuck on hold and never got a person. I probably didn’t TRY hard enough. That said, after many years with no diagnosis and minimal treatment it’s exhausting and it’s hard not to slowly give up and fear having to deal with the constant rejection.
There is one other thing: I had some of my meds but most of them do double duty. They have never increased the allotment, but were refilled. This means that I use the same meds for tension headaches (which become refractory migraines) and neck spasms, one type of pain and others, and also as a rescue med when the migraine meds don’t work.
Ever been stabbed? Last person I know who went got stabbed while crossing the border. Admittedly, this has been a while. Also, medical tourism scares me.
We’re all medical tourists now. We come from the United States to whatever third-world craphole this is, run by His Excellency Colonel Obama.
I have nothing to offer the Right Nurse in the way of advice. Most Americans are dumber than a bag of hammers when it comes to the financial facts of Obamacare. Unless you have a broken arm, something easy to treat you will not find a specialist that will be willing to treat you for something more serious. This has been the case in Canada and Great Britain. Specialists will disappear because there will be no financial incentive for them to specialize.
Malpractice and over-litigation was the initial flaming loop in what has turned into the fiery gauntlet of healthcare. I originally pursued Social Work to be in advocacy, or specialized case management for Behaviorial Health. But after getting a Masters in PA and moving back to Texas, the ambiguous legalese that rules whether State Regs or HIPAA take precedent made every single client a line by line study. All of a sudden I had more paper work than a Public Defender and should have spent my time becoming a poverty lawyer (sorry personal rant). Anyways, this horrible system has been built on incidental circumstance with no analysis or regard for foundation. On the backs of decent people who felt it incumbent on them to keep this machine moving. Nurses, PAs, Social Workers, etc. Now, these people are fed up with lack of pay or being the sacrificial lamb–and the bottom is dropping out as the BS rolls downhill.
Thanks for the info, but I wanted to bring something up just because it is often not discussed. What do you do when a PCP is not someone you can trust or talk with? A good PCP relationship is more than just picking a name out of a book. One person’s PCP may be your nightmare. If you can only change PCPs monthly (and it takes effect the next month), you have 12 tries per year to see if 1) your philosophy of care jives with this person, 2) they will refer you to the specialists need and 3) they are able to care for you in a timely manner. The only way to find this out is to meet the doctor and have that appointment. You may wait weeks for this appointment only to find out that no, this doctor is not right for you. This takes a month out of your period of choice (basically). So now we’re down to 11 chances, maybe 10 if it takes more than 4 weeks to get an appointment (not uncommon around here).
Where does this crap end? Even moreso, how does it end for people with undiagnosed illnesses? I meet 3 of the 4 criteria for Lupus (maybe more). I meet other autoimmune criteria, but not enough. I need a doctor I can trust.
This does not even begin to describe it. I have been offered a job as a Nurse Practitioner, point blank. I am not one. I was told that they would be happy to wait for me to complete my course in 3+ years (assuming I start my program in January). I laughed. I have zero interest in being a primary provider. None.
There is increased risk with no pay off. There are rules, regulations and complete BS that does nothing for the patient, but reduces the payment from Medical, Medicare and insurance companies.
So far, there is: there are fewer regulations on specialties. Surgery not withstanding, specialties do not have exactly the same pressure as the PCP does. In my line of work, everyone wants to specialize because it’s the only way to dodge insurance hell and ensure repayment.
I am disheartened on your behalf. My employer had a CIO who was a former nurse. When OCare passed, he let us know what would happen: in a few years, when the plan starts to take effect, people will be happy. Then, the real impact will settle, rates will go up, providers will go down. Employers will foot the bill because the exchanges will not be helpful. Eventually, it will be more cost-effective for employers to take the financial penalty for not covering their employees than it will to cover them. Everyone will, de-facto, end up in a government run plan. He wasn’t sure when it would become single payer.
I went from a PPO that I loved to a Premium HMO that I tolerated when the company stopped offering PPO. That plan was cancelled this year. There is one HMO offered and a high deductible HSA. I am paying more for a smaller network. My liberal friends say it’s only fair because now they have insurance (many are employed at minimum wage). This is insanity.
I am heartsick for you.
Yes. Legalized euthanasia, for one. Why provide care when you can provide a final solution?
Well, it IS California. Surely nothing that greater administrative efficiency and Silicon Valley couldn’t handle.
I can trust my PCP, but he is not really my primary care physician. He is only so for paperwork issues, since the doc who has really provided the bulk of my primary care stopped being folks’ official PCP. This kinda sorta works for me – everyone involved knows it’s basically what paperwork has forced me into.
This post, and Bob’s comment, prompted me to post. I think this situation will be resolved over time through remote medical expertise and care.
This won’t be helpful, and I know I am preaching to the crowd, but the only thing that will make healthcare better is competition. Doctors that perform procedures that aren’t covered by insurance aren’t [REDACTED]s. They can’t afford to be. Everyone they see are paying for their services out of pocket and can choose to go elsewhere if they don’t like the service. This is the biggest red flag regarding Obamacare. If it were really about providing better healthcare then it would have truly provided for more competition.
I wish I had a better answer for you. Maybe if you can swing it, pay out of pocket once a year for a doctor that you really feel comfortable with.
Also, I have no experience with retail clinics myself, but if you’re in a pinch there are quite a few Walgreens/CVS/Walmart locations nationwide that offer low level urgent care. Typically they’re staffed by providers from well known local physician organizations.