Adventures in Primary Care

In the years since my diagnosis, I’ve often wondered why I needed a primary care physician.  Since my health is all about controlling blood sugars and staving off D-complications these days, I literally have only seen our family doctor two or three times in the past six years.  And then recently, we got a letter informing us that’s she’s retiring… No big deal, right? Wrong!

A couple of things happened:

Coincidentally, right around the time her practice was shutting down, I was having an issue with recurring bladder infections. Ugh.  I discovered that calling my endo’s cell phone to beg for antibiotics was really not the ideal way to go. (Which pills did you have last time? Uh, I have no idea… Are your BGs running high? Um, noooo…  Have you had a urine test yet? Weeelll… )

On top of that, I really wanted to get the H1N1 vaccine, but my endo didn’t have it, and I had no idea where else to turn.

And perhaps most importantly, our insurance had been sending ever-more-urgent letters insisting that we find a primary care physician (PCP), or else. Finally, a letter came announcing that they’d randomly assigned us to some local doctor.  I suddenly remembered that the last time that happened (long before the diabetes, or even the kids), we got stuck with a woman who looked like a grumpy hippopotamus and had the personality to match. If I’ve learned anything in the last 6 years, it’s that you need to like your doctor!

I’ve also learned that you need to play along with the current rules of our healthcare system, as messed up as they may be in some circumstances. OK, so insurance providers insist that you are paired up with a PCP, who — if nothing else — should “order preventative medical screenings” and “provide formal written referrals to specialists.” And get me simple antibiotics and vaccines when I need them, without the 40-minute drive to the City. OK, I’m in.

I didn’t really feel comfortable asking friends for a referral, so I decided to put my money where my mouth is and try searching via Google Health, where I *finally* just started keeping my personal health records online, btw. Lo and behold, I found a great practice just minutes from our home that even has its own website. (That means they “get it,” right ePatient Friends?)

So I made an appointment, and I went there. And I found myself filling out a pile of paper forms in triplicate, committing myself to this new woman’s care even before I had seen her for one single moment in the flesh.

Thankfully, she was nice. And knowledgeable. And apologetic that they can’t share lab results online yet, or communicate with patients via email. “We’re switching to a new EMR service that should be better, but this all takes a while. In the meantime, you can keep bringing in the printouts of your Google Health Records. Thank you,” she said. Me likey.

Well, that was easy, I thought. Just an hour of my time and I now have a friendly new up-to-date PCP — along with a sore shoulder from that gi-normous H1N1 needle (tip: you’ll be fine as long as you Do Not Look)

Did you sign me up with the new doctor too? My husband asked when I got home. (Just picture my facial response – yes, like that!)

And here’s where the insanity of the inefficiency of our system became clear:

1) Hubby calls the doctor’s office to ask if he can sign up as a new patient of Dr. Nice as well. Oh yes, no problem. But don’t we need to let our insurance know that we’re switching to you?  Um, I don’t think you need to do anything special there, the receptionist says.

2) Skeptical of “automatic coverage,” Hubby calls our insurance provider, where the clerk says she’ll look into it and call him back. Later, she calls back to report: Sorry, we can’t assign you this doctor because we can’t find the insurance code for her.  What??

3) Hubby calls the doctor’s office back.  Are you sure you spelled her name right? they ask, and begin to spell it out. Yes. I am on your website right now, Hubby says through his teeth.

4) He gets transferred to the physician’s Billing Department. Give me all of your insurance information and I will contact them right now, says Dr. Nice’s equally nice finance lady. Great. Hubby spells out our name, address and insurance info for the umpteenth time.

5) Finance calls back later to inform us: We’re not in your HMO, but you have POS, which means you can use the HMO or PPO option. Poor Hubby, who is from Germany, looks lost. Oh I know! I say. I researched that a few years ago. It’s the alphabet soup of you-pick-and-you-pay.

Hubby literally spent half a day calling around on this, and came away with few answers.  We’re still not sure if we’re being officially assigned to Dr. Nice, or if every visit with her will be considered an out-of-network expense.

Luckily, we don’t need to see this doctor too often. And luckily, everyone over there is inexplicably nice.  But it makes me cringe to think about fighting through this kind of BS red tape for the benefits we chronic patients really, really need — especially when not everyone is always so pleasant about it all (um, present blogger included).