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Old 03-28-2004, 11:22 AM   #31
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I think that one of the problems is that so many people are patients with HMOs. I know that Kaiser (which is run by Satan himself) doesn't have child psychiatrists on staff. This is a major problem when dealing with children with major disorders. Like Sweetest Thing said, GPs shouldn't be dealing with these problems; they're not trained and experienced, yet frequently they're the only ones available. The HMO rules won't let specialists see patients without referrals, and the GPs can't or won't give referrals for specialists. Meanwhile, unhappy, ill people don't get the care they need.
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Old 03-28-2004, 11:42 AM   #32
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Everyone should require a referral to see any type of specialist. Are there instances where people don't in America? And what is HMO?
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Old 03-28-2004, 05:04 PM   #33
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All of my doctors are specialists. Why should I have to get a referral to see my gynecologist or dermatologist? Why waste my time in my GP's office so he can say "I need you to see someone with more experience and training."


Nope. My doctors and my health are my choice.
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Old 03-28-2004, 05:07 PM   #34
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Blech...I am heavily anti-referral. Trying to get a GP to listen to me is like talking to a brick wall.

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Old 03-28-2004, 05:09 PM   #35
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HMOs are Health Maintenance Organizations that are for-profit health care providers. They tightly control the amount of money the doctors are paid per patient. This results in common and notorious results of poor health care, dead patients, and underpaid and pissed-off docotrs.

My insurance is called a PPO; Preferred Provider O. I don't know what the O stands for. Anyway, for a monthy fee, I can see any doctor within the system, and I pay a fee ($20 right now) upfront for each visit. I also pay 20% of the total for the visit, with my insurance paying 80%. This continues until my "deductible" has been met, meaning that I've paid X amount for the year myself. After that, my insurance pays 100% of any other care that I need.
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Old 03-28-2004, 05:10 PM   #36
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There is no option in Australia. You have to get a referral from a doctor to see a specialist.
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Old 03-28-2004, 05:39 PM   #37
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Quote:
Originally posted by martha

My insurance is called a PPO; Preferred Provider O. I don't know what the O stands for.
"Organization."

I only know because I spent WAY too much time looking at different health care plans before I chose mine.
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Old 03-28-2004, 05:59 PM   #38
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Thank you. I suspected that was it.
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Old 03-28-2004, 09:10 PM   #39
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Quote:
Originally posted by Angela Harlem
Everyone should require a referral to see any type of specialist. Are there instances where people don't in America? And what is HMO?
oh god no, that's a pain in the ass. my husband's insurance is in-network (which is total shit but cheaper) and you have to get referrals for EVERYTHING. basically, you've got your general doctor, dentist, and (if you're a girl) ob/gyn. other than that, you need referrals.

doctors won't necessarily refer you to someone who's covered, so you practically need to bring your coverage book to make sure you don't go through all that to get a referral and he's not even covered. not to mention, you need to make two appointments (one for your doctor, one for the specialist) and pay TWO co-pays. i'd rather ask someone i know for a recommendation, or pick someone who's convenient and will offer me a free consultation.

insurance is shit here, my old dentist requires $150 up front for new patients. insurance or not. and since i've not gone there in so long, i'm considered lapsed so i have to start over. wtf is that shit? medical companies (doctors and insurance companies) take forever to reimburse you anything, it's like they hope you forget. plus you have to keep reminding them and calling them, waiting on hold for an hour. such crap.
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Old 03-28-2004, 11:44 PM   #40
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Even though our system (Australian) is getting shittier and shittier (thanks Johnny!!!) we still do have very good medical cover here. I very rarely have to see a doctor and I am not in any health funds, but I can see a GP for free and get my yearly eye exams and follow ups for free, which is cool and only last month I went and saw a chiropractor for the first time in my life- no referral and it cost $57 for the hour- well worth it. I think our system is great, bulk billing is cool and I dont exploit it- the last time I saw a Doctor was when I broke my foot last year, x-rays, plaster and follow-ups all for free- cool hey!!!!
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Old 03-29-2004, 05:11 AM   #41
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The things you learn each day...

This isn't an opportunistic bashing on America, but your health care system is so unbelievably substandard. Its just shithouse. The reason why there are no specialists without referrals over here is to prevent self diagnosis. If you that headache is a tumour, go see a GP, then get some CAT/CT scans and THEN see the neuro surgeon. We already have waiting lists of 2 years and more to see many specialists, so if people were trying to see them without actually needing it, our system would suffer even more (and ours has its own share of issues).
Private Health Funds and the like have only really grown in popularity over the last 10 or so years as the government started to realise the cost of Medicare is actually crippling them. They're a bit slow...Anyway, neither system is working terribly well as patients are still suffering immense wait times and the shortage of everything from beds to qualified doctors is constantly getting bigger. Private health is a joke. For elective surgeries like some ortho and the like is marginally better as you've paid to your rich health fund so you can jump the queue a bit. But the standard of care is a worrying problem. It is so corporatised and far removed now from any semblance of basic care it is a real worry. $$$ shouldn't be a driving factor in the health of anyone, and it is. It is only a mtter of time until we are like America with virtually no Medicare left at all.

But back to Martha's point for a second, the only time I agree with the idea of no referrals is for ongoing and really lifelong conditions. I'm sick of having to see a GP just to get a stupid letter so I can book an appointment with the Endo I have been seeing for over 10 years.
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Old 03-29-2004, 01:05 PM   #42
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No longer...

I went in for insomnia and after an evaluation he thought it was a side effect of depression. So I went on the first one he prescibed me but soon took myself off, yes it helped me sleep, but I wanted to sleep all day long, I had no lows but I had no highs either, I was just lethargic...not good.

So then I got put on another, this one worked a lot better. I have to admit that this one did help me deal with things a lot easier. But then some of the side effects started depressing me, and just took myself off of them and just gave it up all together.

I went for a follow up and started talking to the specialist and she actually gave me a psycological evaluation. So it ends up more than likely it was all due to a certain form of ADD. I'm now on medication for ADD and have no sleeping problems, no depression, I can fuction at work, retain my thoughts...it's a beautiful day.

I do agree that many are too quick to prescibe meds, but I also do believe that many do really need them.
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Old 03-29-2004, 01:15 PM   #43
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I went to like counseling and stuff and I was told it's hereditary because both my parents have it and I should take medication for it...i've been thinking about it lately.

I know someone that HAS to take Zoloft or they'll have panic attacks
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Old 03-29-2004, 01:49 PM   #44
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Ontario Health Insurance Plan (OHIP) allows that we all have unviersal health care and access to GP when we need it. Other than that, we're a referral-to-specialist province, like Australia. Case and point: I needed a referral from my GP to see the allergist, a referral from the allergist to see the dental care worker, and a referral from the dental care worker to see the oral-facial-maxilall surgeon. It's a hell of a lot of referrals, but yes, it does prevent self-diagnosing and ensures that the people who get help are those who need it. Not to say that our system is without faults, it's not. We have incredible waiting lists to actually see these speicalists--something ridiculous like 6 mo. for an MRI, btu parts of all this is due to the huge shortage of doctors in the province--they're all moving to the states becasue they get paid more there, or all conglommerate around T.O. hospitals and consequently, we have no GPs in rural areas.
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Old 03-29-2004, 01:50 PM   #45
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Normal

Not yet, but I totally should be.

My mom said something the other week about this is "just how my personality is", but god if this is it then why the hell bother?
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