Get Thee to a Doctor! (But Which?)

May 4, 2007 8:13 AM

I currently have what I'd term "crisis" health insurance -- a low monthly bill with a high deductible. I haven't dealt with the plan other than to pay the premiums since I signed up. Now, I think I may have a crisis. Help!

I'm in my early 20s and male. My insurance is of the $500 deductible, 20% copay to $15,000 variety. I've been on it for about year, starting the day I graduated college; I intended to use it as a safety net for severe health problems until I could get a full-time job with benefits, but then wound up working a series of temp jobs sans-benefits. I'm starting the next of these jobs next week. Somewhere in there I applied to and was admitted to grad school, but my student health coverage there (which is quite good) doesn't kick in until mid-August (and I'm moving across the country when that happens, as if this wasn't complex enough already).

Early this week, I noticed something uncomfortable in my reproductive system. I won't go into the specifics here because I already know the answer is "get thee to a doctor." I hung on for a few days hoping it was a temporary thing that'd work itself out, but it hasn't. At this point, I'd like to see a doctor and get a professional diagnosis and treatment, if necessary. My problem is thus: I've been on this plan for about a year and have yet to see a doctor. I checked the plan website last night, and now I have a huge list of physicians in my area.

So the question is, how do I contact one of these people and get an appointment to be seen and evaluated, preferably in the near future, having never met with them before? Given the enormity of the list of providers and the lack of detailed info (I get their name, contact info, and some background on which medical school they attended and when they graduated), what should I look for when I'm choosing which one to call? What can I expect to go through? I'm sure I'm kind of spoiled, because my family had really good health coverage, and my current coverage is not so great.

As an aside, I know and trust my father's primary care physician, but he's not part of my current plan. I have this idea that, since I'm not covered until $500 anyway, if the initial consultation is likely to run me less than $500, I could maybe try and see him and then get a referral to someone inside my plan, if needed. Is this a sane idea?

posted by anonymous to Health & Fitness (14 answers total)

In my area, first visits cost roughly $75, so it might be worth a visit to your father's doctor. If it's a simple problem, you'll only end up spending that money, and you'll be less anxious.
posted by drezdn at 8:23 AM on May 4, 2007

The only issue is that what you spend on an out-of-network provider may not count toward your deductible. Check your policy carefully.

The doc might also insist that you have a complete physical in order to establish a baseline. Some do, some don't. Again, that will be with an out-of-network doc, so whatever exclusion exist will apply.
posted by Thorzdad at 8:29 AM on May 4, 2007

You should probably call your insurance company and ask for clarification on the specifics of your plan.

On my insurance for instance, my copay usually covers typical office visits (so you'd pay 20% of $75, or $15). Then, if they need to complete a procedure, the deductible on the procedure $500. If that's the way yours is set up, you can get the advice from a great doctor inexpensively, then decide on your next course of action.
posted by redarmycomrade at 8:32 AM on May 4, 2007

I chose my doctor by deciding whether I was more comfortable with a woman or a man, deciding I wanted someone in her 40s or 50s (out of med school long enough to have real world experience, but young enough to still know what's happening in the world), and then calling doctor's offices starting with the one closest to me until I found someone who met my criteria. Then I asked the receptionist a few questions about the doctor's bedside manner, and whether she had a type of patient she specialized in.

You could add to this list a question about how much a first-time visit for a medical issue is likely to cost. In my experience, any answer you get is likely to be pretty far off base, because there are different rates for consultation on different issues, and charges for any lab tests, etc., you may recieve.
posted by croutonsupafreak at 8:33 AM on May 4, 2007

Having a doctor you trust is a very good thing. There's nothing wrong with going to him if you can afford it. Though having a doc you trust AND can afford is the ideal.

Insurance does afford you benefits even below the deductible. They've negotiated rates for their customers that are far lower than what an uninsured person gets charged. The full charge could easily be half what it might be at your father's doctor. And then you probably pay only 20% of that. So if cost is your biggest concern, call one of the plan doctors. (Maybe your father's doc can be prevailed upon to look over the list for you and mark those he/she knows are good?)

On the other hand, you may be able to directly negotiate a good discount from your father's doctor. So this isn't an either/or proposition.

Keep in mind that a "new patient" usually gets lowest priority for appointments, which can mean a long wait (months, sometimes, in busy practices). So right now I'd choose whichever doctor takes your phone description of symptoms seriously and is willing to get you in for an exam right away. You're not committed to continuing with whoever you see now, so don't worry over the selection process too much.
posted by nakedcodemonkey at 8:35 AM on May 4, 2007

Also, ask friends and co-workers for the names of doctors they like (and why they like them) and compare those with your insurance company's list.
posted by Robert Angelo at 9:09 AM on May 4, 2007

My advice depends on whether your condition is something simple that you think a doctor would easily recognize and prescribe treatment (e.g., an infection). In that case, go with whomever you can get an appointment with right away. Like nakedcodemonkey said, you're not marrying the person. If all you've got is a bacterial infection, they're going to give you antibiotics and send you home. With a blood test it's pretty easy to see if you've got an infection or not, so your choice of doctor shouldn't much matter.

However, if this condition is something that's a complete mystery to you (e.g., vague pain), then I'd see your dad's doctor for the initial appointment and any follow-ups with a referral in your plan.

(I am not a medical professional of any sort.)
posted by desjardins at 9:14 AM on May 4, 2007

If you're a woman, Planned Parenthood (and other places like them, in some cities) offers sliding scale cash payment for OB/GYN appointments, if you're not sure about the level of "crisis" involved.
posted by availablelight at 9:24 AM on May 4, 2007

duh, just saw the "male" part of the original post. need more coffee.
posted by availablelight at 9:25 AM on May 4, 2007

If you're a woman, Planned Parenthood (and other places like them, in some cities) offers sliding scale cash payment for OB/GYN appointments, if you're not sure about the level of "crisis" involved.

Most Planned Parenthood locations now offer male reporductive health services, too, so it's still an option even though the OP is a guy.
posted by Kellydamnit at 9:36 AM on May 4, 2007

Planned Parenthood isn't only for women. Exact services provided to men probably vary based on location.

That said, pp isn't a good option for you if it can't be applied toward your deductible.
posted by necessitas at 9:39 AM on May 4, 2007

i would recommend seeing a doctor who practices at a hospital. if you have to be referred to a specialist, you'll get better continuity of care--all your records will be in one place. bonus points if there is a teaching hospital in your area (one associated with a medical school).

see someone who's board certified. not all are. that's more important than what school they went to.

i think it's more important to see someone quickly than to find the "right" doctor. if your family physician can get you in and you can afford it, then just do it.
posted by thinkingwoman at 9:50 AM on May 4, 2007

Once you get the name of a physician you're potentially looking at to visit, check out your state medical board records and they should tell you more about the physician's detailed record.
Also.. make sure the physician is board certified in the specialty.

You're best off with seeing a doctor in your own plan because when they make a referral to a specialist (if it goes that far) your plan will most likely cover everything. If you went to your dad's PCP and got a referral, then your plan may have you see one of their PCP's to have you referred within the plan anyways.
I think I just confused myself. :)
posted by czechmate at 9:56 AM on May 4, 2007

Ask your Dad's doc to recommend someone on the list, and do the checking that czechmate recommends. Good luck.
posted by theora55 at 1:28 PM on May 4, 2007