Hello! We might get a chance to switch to a HMO and save quite a bit of money; I’m nervous about a PCP being the gatekeeper to all my care, though, having not had great experiences with this specialty.
Let’s say that I have an HMO. Just off the top of my head, let’s say I suspect that I have IBS. Suppose the PCP says, “No, it’s just stress, I won’t refer you to a specialist,” so, out of desperation, I pay out of pocket to see gastro just for the diagnosis, and the gastro says it’s IBS. I go back to the PCP and say, “The gastro said it’s IBS,” and the PCP says, “Yeah, well, I disagree.”
What would happen to someone with a HMO in that case? Would it be hard to get treatment for the IBS paid for by insurance, even though a doctor did diagnose it? Can the PCP really hold that much power?
Sorry if this is a stupid question. I’ve just had a PPO forever and this is new to me.
submitted by /u/Gingersnappish
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Hello! We might get a chance to switch to a HMO and save quite a bit of money; I’m nervous about a PCP being the gatekeeper to all my care, though, having not had great experiences with this specialty. Let’s say that I have an HMO. Just off the top of my head, let’s say I suspect that I have IBS. Suppose the PCP says, “No, it’s just stress, I won’t refer you to a specialist,” so, out of desperation, I pay out of pocket to see gastro just for the diagnosis, and the gastro says it’s IBS. I go back to the PCP and say, “The gastro said it’s IBS,” and the PCP says, “Yeah, well, I disagree.” What would happen to someone with a HMO in that case? Would it be hard to get treatment for the IBS paid for by insurance, even though a doctor did diagnose it? Can the PCP really hold that much power? Sorry if this is a stupid question. I’ve just had a PPO forever and this is new to me.
submitted by /u/Gingersnappish [link] [comments]Read Morer/HealthInsurance