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New dr drama/ UPDATE

Posted by on Jul. 24, 2013 at 3:59 AM
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I have taken the last few days to call EVERY primary dr on the insurance list. NO ONE is taking new patients. One office said they had a new doctor coming in October or December. That does not help. There are no approved pain management drs in the area taking the insurance. I called the insurance and was told the primary had to call. They called and was told I had to call for an exception. I have spent hours on the phone. So, I called again. I was told that the specialist has to call and ask for an exception. Why do they need to do that...their answer is they don't take my insurance. Case closed. So, I either pay out of network benefits of $500 deductible plus 40% of additional charges or I can't see a dr. Well, I literally have a nickel in my checking account until my disability check comes on the 3rd. I don't have $500 extra dollars in my budget. It looks like I am totally screwed. I have asked for directions on how to titrate off of the medications I have taken for 10 years. I know that given the pain level I tolerate while on meds, I will be suicidal within a week. I have trouble getting out of bed to go to the bathroom. as it is.  I have totally useless insurance. One insurance rep told me to just go to the ER. Hello---they don't serve as a chronic condition provider and should not. 


IMy wonderful dr closed her practice in May. She is 42 and said she just needed a break from the day to day stress. Getting a dr in my area is almost impossible and when you are on Medicare, it is just about impossible. I called over 100 drs and finally was told that an approved practice had a dr joining them in July. I was told to get my dr to write prescriptions for my meds through July and the new dr did not prescribe anti depressants or anti psychotics. OK....the only anti depressant I take is for fibromyalgia and I can get my rheumatologist to do that.

I have lupus, rheumatoid arthritis, osteo arthritis, fibromyalgia, severe osteoporosis, 2 herniated discs, degenerative disc disease, cervical radiculapathy, spinal stenosis, and several other medical problems. I am on a lot of meds including 2 pain meds. 

I met the dr today. Well, he does prescribe anti depressants, but will not touch pain meds. Now, I am screwed. He said I would have to see a pain specialist. I have driven 100 miles to Dallas, seen one who approved the plan, but will not see me as a regular patient due to the distance. There is not ONE pain management specialist approved on my insurance plan in the Waco area. 

I am obese and the dr is SUPER OBESE. He asked if I had considered lap band surgery. I responded no and lupus patients CANNOT have lap band....if he just researched it, he would know that. Also, I have had 7 abdominal surgeries and have horrible, horrible problems with wound healing including incisions that have split open and others that had to be opened due to massive infections....all of which make me a poor candidate for any bariatric surgery. Also, I have SEVERE osteoporosis and am on daily injections for it which cost the insurance company $1400 a month. My t score is incredibly out of range for any bariatric surgery since vitamin malabsorption and osteoporosis are known side effects for bariatric surgery. I am on forteo which is a hard drug to have insurance approval. Although I brought my medical records, he honestly asked if I had a dexi scan. Um, yes, they would not know my t score without one. He commented on the amount of thyroid meds I am on. Yes, I have been hypothyroid for almost 40 years, have a goiter, and have had multiple thyroid nodules. I get the level checked every 3-6 months.....is it any wonder I am over weight?

I have lost 104 lbs on my own....I need to lose another 80-100 lbs., but bariatric surgery is not in my future. It took all of my restraint to not ask if he, whose stomach was dragging below the chair, had considered surgery. He wanted to see my surgery scars....His response was that I clearly had healing issues after seeing the massive scars. What, did I make up having massive surgeries?

I have fought tears all day and the appointment was at 9 am. I just don't know what to do. I called the insurance. They gave me the name of a pain dr...turns out, there is no dr by that name here and the phone number is to another practice. Turns out, the dr is a neurosurgeon in McKinney almost 130 miles from here. 

I miss my wonderful dr and just don't know what to do. 

by on Jul. 24, 2013 at 3:59 AM
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Replies (1-8):
dana63
by Momma of 40ish on Jul. 24, 2013 at 6:02 AM

 I am so sorry!! I know you said you traveled to Waco (I live in the Killeen area) and was wondering if you considered going to Temple Scott & White? I know they have a great doctors who could most likely help with your condition and they take medicare.

Hugs

tossed
by Bronze sister on Jul. 24, 2013 at 6:08 AM

Quoting dana63:

 I am so sorry!! I know you said you traveled to Waco (I live in the Killeen area) and was wondering if you considered going to Temple Scott & White? I know they have a great doctors who could most likely help with your condition and they take medicare.

Hugs


I live in Waco. Scott and White is not approved on my health plan. I used to have a plan that covered Scott and White and really had a "hit or miss" with their doctors. I could not stand their rheumatologists...yuck. I loved my primary through S and W, but he was laid off when they did a major restructuring. Scott and White bought out the Hillcrest system in Waco, so I can't see any of their physicians now either. I have a Medicare replacement plan since it is the only way I could afford treatment. Traditional Medicare was destroying my pocketbook.
dana63
by Momma of 40ish on Jul. 24, 2013 at 6:17 AM

 I dont know any of the hospitals in that area but in my area we have two that are not S&W. Seaton is really good but I dont know what insurance they cover. I know I have to get the right dr as well and was blessed to find a good one...

Quoting tossed:


Quoting dana63:

 I am so sorry!! I know you said you traveled to Waco (I live in the Killeen area) and was wondering if you considered going to Temple Scott & White? I know they have a great doctors who could most likely help with your condition and they take medicare.

Hugs


I live in Waco. Scott and White is not approved on my health plan. I used to have a plan that covered Scott and White and really had a "hit or miss" with their doctors. I could not stand their rheumatologists...yuck. I loved my primary through S and W, but he was laid off when they did a major restructuring. Scott and White bought out the Hillcrest system in Waco, so I can't see any of their physicians now either. I have a Medicare replacement plan since it is the only way I could afford treatment. Traditional Medicare was destroying my pocketbook.

 

cafe.gif (14184 bytes)Join us for coffee~~

tossed
by Bronze sister on Jul. 24, 2013 at 6:26 AM


They are not showing up on the list either. This SUCKS. I know what you mean about the right dr. I was stuck with taking the ONLY dr who was taking new Medicare patients...He graduated from med school in 2010 and just joined the practice here this month. I called 100 drs before finding this one. The insurance company said they had tons of drs, but NONE of them are taking new patients. It is hard because I LOVED my former dr. This guy might be okay in a decade or so, but not now. 

Now, I am looking at withdrawl from the meds since he won't prescribe them and I can't find a PPO approved pain dr. If I go out of network, I have to pay the first $500 and then 40% of the cost. I don't have money for food for the rest of the month...no way can I pay $500 for a dr's visit(s). 

Quoting dana63:

 I dont know any of the hospitals in that area but in my area we have two that are not S&W. Seaton is really good but I dont know what insurance they cover. I know I have to get the right dr as well and was blessed to find a good one...

Quoting tossed:


Quoting dana63:

 I am so sorry!! I know you said you traveled to Waco (I live in the Killeen area) and was wondering if you considered going to Temple Scott & White? I know they have a great doctors who could most likely help with your condition and they take medicare.

Hugs


I live in Waco. Scott and White is not approved on my health plan. I used to have a plan that covered Scott and White and really had a "hit or miss" with their doctors. I could not stand their rheumatologists...yuck. I loved my primary through S and W, but he was laid off when they did a major restructuring. Scott and White bought out the Hillcrest system in Waco, so I can't see any of their physicians now either. I have a Medicare replacement plan since it is the only way I could afford treatment. Traditional Medicare was destroying my pocketbook.

 



dana63
by Momma of 40ish on Jul. 24, 2013 at 6:35 AM

 I would be calling my insurance provider and letting them know that they need to update their records. How far do they allow you to travel? I also have fibromyalgia/RA and DDD and I take no medication because my pain level is different than most and because I have the mind set of not taking medication so no meds will work according to my dr.

Quoting tossed:

 

They are not showing up on the list either. This SUCKS. I know what you mean about the right dr. I was stuck with taking the ONLY dr who was taking new Medicare patients...He graduated from med school in 2010 and just joined the practice here this month. I called 100 drs before finding this one. The insurance company said they had tons of drs, but NONE of them are taking new patients. It is hard because I LOVED my former dr. This guy might be okay in a decade or so, but not now. 

Now, I am looking at withdrawl from the meds since he won't prescribe them and I can't find a PPO approved pain dr. If I go out of network, I have to pay the first $500 and then 40% of the cost. I don't have money for food for the rest of the month...no way can I pay $500 for a dr's visit(s). 

Quoting dana63:

 I dont know any of the hospitals in that area but in my area we have two that are not S&W. Seaton is really good but I dont know what insurance they cover. I know I have to get the right dr as well and was blessed to find a good one...

Quoting tossed:


Quoting dana63:

 I am so sorry!! I know you said you traveled to Waco (I live in the Killeen area) and was wondering if you considered going to Temple Scott & White? I know they have a great doctors who could most likely help with your condition and they take medicare.

Hugs


I live in Waco. Scott and White is not approved on my health plan. I used to have a plan that covered Scott and White and really had a "hit or miss" with their doctors. I could not stand their rheumatologists...yuck. I loved my primary through S and W, but he was laid off when they did a major restructuring. Scott and White bought out the Hillcrest system in Waco, so I can't see any of their physicians now either. I have a Medicare replacement plan since it is the only way I could afford treatment. Traditional Medicare was destroying my pocketbook.

 

 

 

 

cafe.gif (14184 bytes)Join us for coffee~~

tossed
by Bronze sister on Jul. 24, 2013 at 6:52 AM


They would let me travel to Houston or El Paso if I was willing, but I cannot. I had to take my son to Killeen and Temple for part of his clinical rotations and just sitting that long in a car takes me 1-2 days to recover. It is not something I could afford to do every month...which would be required due to one of the meds being a triplicate. I don't take as many meds as many drs would want me to take...I take far less over all than I used to. Some people can handle the list of things wihtout pain meds and that is great if they can....I cannot. Before we found a combo that just takes the edge off of the pain, I was suicidal. Believe me, that has really crossed my mind in the last day. I hurt 24/7 even with the meds, but at least it was not the sharp stabbing pains I had without the medication. I am looking up drs 100 miles away, but am only finding anestheologists (and I don't want a lot of steriod injections in my back...been there, done that.) 

It looks like I am screwed.

I have gone over and over the lists of providers with my insurance co. They gave me the list of primary care drs who were supposedly taking new patients. Well, after finding out that 100 of the drs on their list were either not taking patients, had wrong numbers, etc. I spoke with a guy in the department that is responsible for the lists. He blamed it on the providers. Just to prove a point, I asked if the dr I had who just closed her practice was taking new patients....response...well of course she is. BS and called them on it. They don't update things at all and you end up spending precious time calling doctors off of a horrible list.




Quoting dana63:

 I would be calling my insurance provider and letting them know that they need to update their records. How far do they allow you to travel? I also have fibromyalgia/RA and DDD and I take no medication because my pain level is different than most and because I have the mind set of not taking medication so no meds will work according to my dr.

Quoting tossed:


They are not showing up on the list either. This SUCKS. I know what you mean about the right dr. I was stuck with taking the ONLY dr who was taking new Medicare patients...He graduated from med school in 2010 and just joined the practice here this month. I called 100 drs before finding this one. The insurance company said they had tons of drs, but NONE of them are taking new patients. It is hard because I LOVED my former dr. This guy might be okay in a decade or so, but not now. 

Now, I am looking at withdrawl from the meds since he won't prescribe them and I can't find a PPO approved pain dr. If I go out of network, I have to pay the first $500 and then 40% of the cost. I don't have money for food for the rest of the month...no way can I pay $500 for a dr's visit(s). 

Quoting dana63:

 I dont know any of the hospitals in that area but in my area we have two that are not S&W. Seaton is really good but I dont know what insurance they cover. I know I have to get the right dr as well and was blessed to find a good one...

Quoting tossed:


Quoting dana63:

 I am so sorry!! I know you said you traveled to Waco (I live in the Killeen area) and was wondering if you considered going to Temple Scott & White? I know they have a great doctors who could most likely help with your condition and they take medicare.

Hugs


I live in Waco. Scott and White is not approved on my health plan. I used to have a plan that covered Scott and White and really had a "hit or miss" with their doctors. I could not stand their rheumatologists...yuck. I loved my primary through S and W, but he was laid off when they did a major restructuring. Scott and White bought out the Hillcrest system in Waco, so I can't see any of their physicians now either. I have a Medicare replacement plan since it is the only way I could afford treatment. Traditional Medicare was destroying my pocketbook.

 



 



jmlmomma
by Momma's new BFF on Jul. 24, 2013 at 7:21 AM

 I would check into the laws to see how far you have to be out of a coverage area before they HAVE to let you go to a Dr. in the area your in. It maybe 100 miles... 

Insurance SUCKS we pay $2500.00 a month for our 4 employees to have coverage, and for over 3 years we could go the hospital in our town because it left our insurance company... THAT should be illegal! 

AndrewsMomPDX
by Christine on Jul. 24, 2013 at 7:33 AM

Hugs to you, as it sounds like you are doing everything you can.

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