To Elephantman @ 7:34

(And to the Salon reader who said that their relative was tied into a certain primary care provider because of insurance, you'll have to explain that one. Has anybody ever heard of a health care plan that dictates one and only one doctor, by name, whom a patient must use? I don't believe it, and I don't believe you.)

What reality are YOU in? Lots of HMO plans stipulate that you have to make a choice of doc and/or clinic, in order to get the fullest [monetary] coverage. [Of course they have contingency plans for emergencies, etc., but the patient has to pay more or play "jump through the insurance company's flaming hoop" to get similar benefits from non-chosen docs and facilities]. Often this option is the cheapest, and if one must have insurance, this is the price you have to pay. Reality. Sux.

--Anonymous

No, I still don't believe you. What you originally implies that a particular primary care doctor had been arrogant and unresponsive. And the third-party payor said essentially, "We don't care if you don't like that doctor; you have to go to that doctor."

And, no, I don't believe that any insurer operates that way. Some HMO plans may require that all subspecialty referrals be 'within system', or that specialty referrals only be made through the primary care doctor, whoever that may be...

But no, I still don't believe that there is an insurer whose policy states that the insurer will choose the individual doctor and the patient has no choice.

Is that the story that you are trying to peddle?

Below is the Salon version, which I take to mean, "Yes, Elephantman, you were right; nobody demands that you have to see a certain single doctor, and only in the strangest of circumstances is your choice effectively limited altogether."

@ To Elephantman

Most insurance plans have a list of approved Primary Care Physicians. Yes most do allow a patient to go outside the list but there is usually a substantial charge for using an ‘out-of-plan’ doctor (ie, the plan only covers 20% of cost rather than 80% for in house or higher costs for check ups etc etc all designed to discourage the use of out-or-plan doctors by make the cost prohibitively expensive).

Now here’s the fun part. Many of the ‘in-plan’ doctors already have maximum patient loads and are not taking on new patients. So just finding a primary care provider is usually a matter of going down the list of doctors and phoning each office to find the one or two who are taking on new patients. Once you’ve picked that PCP you’re pretty much stuck with them. The only way to see another doctor (without paying a substantial penalty) is with your PCPs approval.

And trying to switch PCPs is a load of fun. First off, you’re stuck with the list of doctors the insurance company approves and again you have to find one willing to take on new patients. And you if can’t find one willing to take new patients (which does happen, I’ve seen fellow employees in tears because they can’t find a doctor) then you are stuck with your current PCP unless you want to and have the money to go outside the approved list of doctors.

So yes it is very possible for the insurance company to trap you with a doctor you don’t like and you have no effective/affordable means to get away.

-- thorin01

Then we have the latest in medical lies from John Edwards (you need a spreadsheet to keep track of all of those!):

http://online.wsj.com/public/article/SB119967240787671395.html?mod=blog

If you really want to hear some great urban legends and popular myths concerning healthcare, you don't need to log on to Google. Just sign up for the Edwards campaign's e-mails, and they will be delivered to you automatically!

The CDC conducted focus groups a few years ago to determine where/how physicians acquired information/knowledge on little-known disease processes. This was done in conjunction with DES Action USA to determine the best way to educate physicians and patients to the needs of that particular population.

The patients were coming into the doctors office armed with information and research compiled by the advocacy group. The physicians were not knowledgeable on the subject matter and they had preconcieved (wrong) assertions about the diagnosis and treatment of many of the symptoms and problems associated with the exposure.

What was determined was that doctors in practice do not have the time to research (whether over the internet or in their own professional journals) little known disease processes. Some (in teaching institutions) have their residents do their researching for them... but on the whole? There's just not enough time. Physicians in private practice either catch it on the fly.....or in continuing education programs offering limited (and perhaps biased?) information.

...

-- Mol

DES Action USA is an advocacy group funded by the attorneys and other interested parties in the nationwide DES litigation. I am a little shocked to think that the our government's CDC is operating in concert with such an advocacy group.

And it does not surprise me at all that ordinary practitioners in internal medicine, ob-gyn, or other primary care positions, would not be up on every medical detail developed through litigation, which is a remarkably false environment for medical science. There were enough phony and inflated claims (among a very few legitimate ones) in that mass litigation to fill a large encyclopedia.