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I don't understand how my health care works
- Aug 27, 2009 at 9:48 AM
- By
- Comments (7) Total Views (107) Everyone can see this journal post.
In the military, I made an appt with the flight surgeon or even the Women's Clinic (for myself) or with the pediatrician (for the kids). If I needed a referral to a specialist, I got one. Easy. Of course, because my DH was a WSO, I was treated like a princess. We never had any problems with Tricare Prime. I got great medical care.
When I was diagnosed with cervical cancer (more like a pre-cancerous condition that scared the hell out of everyone) I went from "Hmm, abnormal Pap smear" to "Hysterectomy now!" in 3 months. June, ordinary "girl" appointment. July, "abnormal Pap smear, let's do the next step with the little snip thing." August, "real live biopsy, please." September, "yank those babies out!"
Which, btw, I was fine with. I was done having kids and I always hated my period. I hated the feeling of being betrayed and misused by my own body. The hormone swings were horrific and I'm glad that they've largely abated. I do still have ovaries, so the hormones are still there, but I don't have to deal with the depression and inexplicable rage anymore. I spent two weeks out of every month walking on egg shells because I wanted to lash out at everything.
Anyway, that was by way of illustrating that I loved military health care.
Civilian health care is extremely confusing.
I have to randomly find some doctor by scrolling down a list of people who take my type of insurance. Recommendations are practically useless because the doctor your friend likes may not be on your insurance plan.
But let's say I have a GP. If I have something wrong with my knee (which I do) am I supposed to go to him first? Because I did that a year or so ago. He x-rayed it, said there was nothing broken (duh) and that I should do strengthening exercises.
What's the next step? Should I find a different GP (he's fine at the normal stuff and I like the PA who does the 'girl' exams)? Or am I supposed to go wandering off to find an orthopedic dr somehow? I mean, I didn't even know what kind of specialist I needed until I mentioned it to some friends.
I swear to you, I am a fairly bright person. I'm just completely lost and have no one to guide me through this mess. I don't think even DH has a good handle on this, to be honest. He just kind of tossed the insurance cards on my desk and ran.
Anyway, I don't know what my next step should be. Any suggestions?
Comments:
i love my tricare! but we aren't anywhere near a military base here...so we kind of follow the "regular" health care paths BUT
big BUT there
if i want a specialist...they put a referral in...i go see the specialist...i pay NOTHING
i go to the emergency room because my daughter wakes up with a fever and unable to open her eyes. simple conjunctivitis...i pay NOTHING...and i don't have to fight with my insurance to get it covered...they just do.
i did get to choose my daughter's health care provider and my health care provider. it just took a phone call. in the network? yes. ok then...there you go ma'am.
i make multiple trips to the ER because kiddo decides to swallow a dime, but not pass it. tricare sends a letter...lots of trips...is there someone we can go after? swallowed a dime so nope. ok...thank you then....
okay, I'm confused. Are you still on Tricare Prime (or Tricare Standard)? If not, what insurance are you on? That's the most important thing to figure out first -- all insurances are different. If you're on an HMO, you have to go to your primary care dr. first and have them put in a referral. If you aren't, then you *may not have to do that. Most insurance companies have a # to call that will run you through what to do next. But if you tell us what kind you have, maybe somebody here has that same insurance and can be a big help to you.
We've got a civilian health care plan now. Tricare Standard is our backup, not our primary. It's United Health Care. *sigh*
Ahh okay. Unfortunately, I don't know a thing about United Health Care (I do know about Tricare Standard, but since that's your secondary insurance, that doesn't really help too much). I'd try calling them and finding somebody who can sit down and answer your questions. I looked them up online, but didn't see a # (not sure what state you're in), but you can probably find one on your statements. I'm sorry that you're having such problems. They just don't make things easy these days. But I would say that if you're still having problems with your knee and your dr. said to just do strengthening exercises, did he give you exercises to do? If not, perhaps you can go back and ask him for a physical therapist referral (if a referral is needed) or what he thinks your next step should be (perhaps it should be an orthopedic dr.). Even if you don't need a referral, I think I'd go back to him (or another GP if you'd prefer) and see what they think your next step should be. Unless you have to pay for each visit. If so, then I'd go directly to an orthopedic unless you have to get a referral. Of course, the finding out if you have to get a referral is the most important thing. You could end up owing for the whole visit, etc. if you were supposed to get a referral and don't. uck. Good luck!!
LOL! See! That's my problem exactly! I have no idea which step to take!
My oh-so-helpful husband said, "Go wander around their website and see what you can find out."
I'm a big chicken, though, and need to get my feathers in order before I brave the intricacies of an insurance company's website.
I went to their website and it didn't look that bad, hon. But honestly, I'd call them first. I'd be willing to bet there is somebody there who can help you. {{{{}}}}
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I am voting popular! I am sorry I cannot help you because I am in the same boat as you... except its my back and knees and hips and ankles. I think I need a chiropractor but my Primary Physician says there is nothing wrong, that I just need strengthening exercises.
I will pass this around as well if thats okay and get the word out there. And in the process get us and others some understanding!
I seriously think that some doctors dont want us to get fixed completely because then we keep coming back and they make more money that way. Sad but true.
- MamaCass05
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