jecochrane
07-08-2006, 10:31 PM
Hey everyone, I just recently got some health insurance and want to start taking a proactive approach to healthcare. I'm really new to all of this, my mom would take care of setting up all my appointments before, so my question is: What type of doctor should I see? I'd really just like to get a complete checkup, but I do know that I have sinus issues (sinusitis) that are really causing me problems. Should I just go to a general practitioner first or should I go to a nose/ear/throat doctor? I'd also like to goto a dermatologist sometime, but that would be three different doctors + a dentist, that I would have to go see. Is there any easier way, like doctor consolidation or something? lol
Thanks in advance.
Josh
Thanks in advance.
Josh
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GLSheridan
07-08-2006, 11:01 PM
Hey everyone, I just recently got some health insurance and want to start taking a proactive approach to healthcare. I'm really new to all of this, my mom would take care of setting up all my appointments before, so my question is: What type of doctor should I see? I'd really just like to get a complete checkup, but I do know that I have sinus issues (sinusitis) that are really causing me problems. Should I just go to a general practitioner first or should I go to a nose/ear/throat doctor? I'd also like to goto a dermatologist sometime, but that would be three different doctors + a dentist, that I would have to go see. Is there any easier way, like doctor consolidation or something? lol
Thanks in advance.
Josh
First of all, find out what your insurance requires to see a specialist (such as the ENT or dermatologist). Many insurance plans require a referral to see these specialists, and they will not cover the services unless the referral is authorized by your primary care doctor.
Since you mentioned a general check-up, I'd recommend just seeing a general practitioner for now. You can consult with him/her, and s/he may be able to offer you solutions to your problems without seeing a specialist. You can of course ask the general practitioner if s/he would recommend a specialist (which you'll definately have to do if your insurance requires referrals).
Thanks in advance.
Josh
First of all, find out what your insurance requires to see a specialist (such as the ENT or dermatologist). Many insurance plans require a referral to see these specialists, and they will not cover the services unless the referral is authorized by your primary care doctor.
Since you mentioned a general check-up, I'd recommend just seeing a general practitioner for now. You can consult with him/her, and s/he may be able to offer you solutions to your problems without seeing a specialist. You can of course ask the general practitioner if s/he would recommend a specialist (which you'll definately have to do if your insurance requires referrals).
jecochrane
07-08-2006, 11:20 PM
Hmmm...thanks I didn't know that. I took a look at my providers FAQ: http://www.sagamorehn.com/main.asp?view=sagamore&page=faq-ppo.
"Q. What if I need Specialty Care? Can I choose the specialist? Must it be a Sagamore physician?
A. The decision is yours. Sagamore physicians should refer you to other Sagamore providers. If you choose to use an out of network physician or provider, however, bear in mind you will be subject to OUT of network benefits and will likely have to pay more out of your pocket.
"
So it says the decision is mine, but a physician should refer me? I'm taking that as I can do what I want, but they'd prefer me be referred...
*Edit* Also, how do I choose a primary care physician?
Thanks.
Josh
"Q. What if I need Specialty Care? Can I choose the specialist? Must it be a Sagamore physician?
A. The decision is yours. Sagamore physicians should refer you to other Sagamore providers. If you choose to use an out of network physician or provider, however, bear in mind you will be subject to OUT of network benefits and will likely have to pay more out of your pocket.
"
So it says the decision is mine, but a physician should refer me? I'm taking that as I can do what I want, but they'd prefer me be referred...
*Edit* Also, how do I choose a primary care physician?
Thanks.
Josh
jcjwillis
07-09-2006, 11:03 AM
Usually your insurance company will provide you with a list of doctors that are in theit network. Simply choose one and go to him or her.
I personally would ask around to different people and see if they like their doctors and get a reccomendation from them. The same thing applies to a specialist as well as your general practioner can you you a name of specialists that he reccomends.
I personally would ask around to different people and see if they like their doctors and get a reccomendation from them. The same thing applies to a specialist as well as your general practioner can you you a name of specialists that he reccomends.
GLSheridan
07-09-2006, 03:20 PM
Hmmm...thanks I didn't know that. I took a look at my providers FAQ: http://www.sagamorehn.com/main.asp?view=sagamore&page=faq-ppo.
"Q. What if I need Specialty Care? Can I choose the specialist? Must it be a Sagamore physician?
A. The decision is yours. Sagamore physicians should refer you to other Sagamore providers. If you choose to use an out of network physician or provider, however, bear in mind you will be subject to OUT of network benefits and will likely have to pay more out of your pocket.
"
So it says the decision is mine, but a physician should refer me? I'm taking that as I can do what I want, but they'd prefer me be referred...
*Edit* Also, how do I choose a primary care physician?
Thanks.
Josh
It really depends what plan you have. If you have the PPO, you can refer yourself to a specialist, and you're not required to select a PCP. The POS plan requires referrals to specialist to get the highest benefits. If you're still not totally sure, consult with a customer service representative before making any appointments. You don't want to get slapped with a hefty bill because the necessary steps weren't taken.
As far as PCP selection, it doesn't appear that your insurance company makes you formally select a PCP. It looks like you can just go to whatever participating PCP you'd like. However, I'd suggest asking customer service if they suggest that you formally elect a PCP for their records. If referrals are needed, sometimes things can get sticky if you've never really selected a PCP.
"Q. What if I need Specialty Care? Can I choose the specialist? Must it be a Sagamore physician?
A. The decision is yours. Sagamore physicians should refer you to other Sagamore providers. If you choose to use an out of network physician or provider, however, bear in mind you will be subject to OUT of network benefits and will likely have to pay more out of your pocket.
"
So it says the decision is mine, but a physician should refer me? I'm taking that as I can do what I want, but they'd prefer me be referred...
*Edit* Also, how do I choose a primary care physician?
Thanks.
Josh
It really depends what plan you have. If you have the PPO, you can refer yourself to a specialist, and you're not required to select a PCP. The POS plan requires referrals to specialist to get the highest benefits. If you're still not totally sure, consult with a customer service representative before making any appointments. You don't want to get slapped with a hefty bill because the necessary steps weren't taken.
As far as PCP selection, it doesn't appear that your insurance company makes you formally select a PCP. It looks like you can just go to whatever participating PCP you'd like. However, I'd suggest asking customer service if they suggest that you formally elect a PCP for their records. If referrals are needed, sometimes things can get sticky if you've never really selected a PCP.
BioAdoptMom3
07-09-2006, 08:45 PM
Most GPs or family physicians can handle all the problems you mentioned. You need one anyway for those times when you wake up sick, need a general check-up, etc.
Nancy
Nancy