Medical care (HMO) question

Discussion in 'Teacher Time Out' started by John Lee, Jul 6, 2015.

  1. John Lee

    John Lee Groupie

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    Jul 6, 2015

    So I'm looking to get a lot of my ailments taken care going forward... all of them happen to be physical-related (i.e. sports). Both my knees suck and could probably use surgery. I have a left shoulder that needs surgery as well, and my right shoulder is not great either. Maybe the biggest in all this is a neck problem that has been with me a decade, along with a balky back. None of these prevents me from lifting weights, running, that I can't stay in reasonably fit and athletic shape. It's just all for show though (the injuries prevent me from playing the sports I'd like to).

    Anyway, I'm planning on seeing a doctor for the first time in over a decade for my ailments. I'm bring this here, because I'm on an HMO plan that I can't change til January. That means, I'm stuck with doctors I'm not able to choose, and all the hassles that go along with HMO plans. Earlier this year, I tried to go to various sports medicine/chiros for my neck that were recommended to me by my friends--but was turned down because I have HMO.

    So at this point, I wonder what my best course of action would be until January (when I can choose who I go to). I'm thinking: Which things can give me the best benefit? Going for those areas that most certainly need surgery (my knees, shoulder) doesn't seem like something I should do. It would be GREAT, because I'm obviously not working during the summer. But I don't want some doctor from St. Barths University diagnosing or operating on me.

    Since I'm not looking for surgical procedures for my neck and back but I do want sports therapy/chiro work on those areas... I'm thinking that I should do that? And then just change to sports medicine/chiros of my choosing come January?

    The other thing is that I'm sure I'll need MRIs done on my shoulders/knees... should I go in for those things now? (i.e. Those seem like things you can't mess up.) Would that speed up the process come January? Sorry for ramble, thanks for reading.
     
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  3. Kat53

    Kat53 Devotee

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    Jul 6, 2015

    I had so many problems on an HMO that I will never go back to one. If you plan on getting surgeries once you change plans, then the new doctors will more than likely request their own MRI's. I would wait to get those tests once you see a specialist. My opinion would be to wait for everything until you change plans, or do some googling and find out about surgeons that are on your HMO. There are some great ones, but you might need to do some serious pushing with your insurance company to get the tests approved. I went through this hassle two years ago and it was a nightmare. I've never understood why my doctor (who is a medical professional) could order some tests and my insurance company (who are not medical professionals) could deny them. Sorry for the rant. Good luck!
     
  4. John Lee

    John Lee Groupie

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    Jul 6, 2015

    Thanks for replying.

    I think I just want to get referred to a chiropractor for my back/neck issues, and receive treatment on that for the next six months. In that scenario (in my mind), I'm just thinking I need to go to my primary doc and get him to refer me to a guy after giving me the once-over. You're saying (in your experience) that it won't be that simple?
     
  5. Kat53

    Kat53 Devotee

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    I think you should be fine with a chiropractor referral. My situation was probably abnormal. I had abdominal pain and went through four months of diagnostic tests that I had to fight tooth and nail for. I'm still bitter if you can't tell.:lol::lol:

    ETA: to be fair, I had some really awesome specialists on my HMO, the pain was having to get the referral and get through Cigna's horrific red tape.
     
  6. czacza

    czacza Multitudinous

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    Jul 6, 2015

    Chiropractic care has made such a huge difference in my well-being.
     
  7. John Lee

    John Lee Groupie

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    Jul 6, 2015

    That is encouraging!

    Hey, your story isn't uncommon with HMOs. It's why I'm broaching the subject anyway. You guys have me somewhat optimistic now!
     
  8. John Lee

    John Lee Groupie

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    Jul 10, 2015

    Just to follow up: Went to visit for my neck and back, doctor referred me to get x-rays... I'm supposed to receive something back (confirmation to go ahead) with x-rays in the next 1-2 weeks... after that he says, he can go ahead and refer me to a chiropractor/specialist to receive treatment. My hope was to get immediate referral/confirmation for treatment, but I suppose that was optimistic.
     
  9. kpa1b2

    kpa1b2 Aficionado

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    Jul 11, 2015

    With my hmo I've always chosen my own specialists. My dr. usually recommends someone who I may or may not use. As long as they take my insurance I'll go see them.
     

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