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Thread: help with doctor and ppo ins.

  1. #1
    Join Date
    Jul 2006
    Location
    michigan
    Posts
    4

    help with doctor and ppo ins.

    Where do I begin .44, I have congen scoliosis w a lower rotation. was treated with a brace 8 til age 16. Since then, Physical therapy, excercise therapy, home therapies(ice, decompression exc.,etc.)
    My primary care physician, recently started steroid injections into the adjoining area for spasms. The problem is twofold.
    1. All the muscles on the entire left side of my spine are constantly in spasm from trying to support my spine. I only can get 1 shot at a time, thus alleviating only a little of the pain. That is very frustrating. the only other treatment optiion offered by him, is heavier pain medication.
    2. What really bothers me though, is that is will not refer me to an osteopath, or other even get a current ex-ray of the spine! When asked, he stated that looking at an exray would not change his treatment(s).It seem like common sense to me, that to treat any condition you would need to know with a fair amount of specificity what your "dealing" with???
    He is an MD who is a general practitioner, (at which he seems very good at). How can I get him to refer me to a scoliosis specialist? I'm pretty sure the real culprit is my ppo insurance. Please help

  2. #2
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,801
    Wow! I've never heard of a PCP doing injections. I don't really have any advice for you (other than trying to switch insurance to a PPO). Good luck!

    --Linda

  3. #3
    Join Date
    Sep 2003
    Location
    NJ
    Posts
    1,291

    Lightbulb

    See if this link can help with sorting out your options:


    http://www.kff.org/consumerguide/7350.cfm
    Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
    Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

  4. #4
    Join Date
    Jul 2006
    Location
    michigan
    Posts
    4
    Thanks for the link Karen, that is most helpful.
    Linda, I have HAP ppo I think. ....time to start researching....if only I could understand these complex legal and medical terms......any links for teminlogy out there???........... Thx Diane

  5. #5
    Join Date
    Jan 2006
    Location
    Houston TX
    Posts
    288

    change your primary carer physician

    If you don't like your treatment, you need to change your PCP. If you have an HMO, you need to find the form needed to do so. You can change at any time, but usually no more than once a month.

    If you have a PPO, you can just go to a new doctor as long as the new physician is in your plan. The insurance company will have a list. You can call them to find out how to get access to it. (paper copy or electronic)

    You may ask some friends about their doctors to find out who they like--a good PCP knows when to send you to someone else.

  6. #6
    Join Date
    Mar 2005
    Location
    east coast
    Posts
    359
    PPO is the 'best' managed health care plan one can have... you can probably goto specialists without a referral, but read your plan policy document.

    My previous PPO did not require referrals and my current POS (a step down from a PPO) don't either. Actually, the HMO my work offers does not require referrals either..

  7. #7
    Join Date
    Feb 2007
    Posts
    3

    PPO network providers

    You will be able to go to any doctor or facility that you like in a PPO. However, you will save money if you choose a doctor or facility that is considered "in-network" (that is where the preferred part of Preferred Provider Organization comes in). You will not need a referral and you will not need to choose a primary doctor in a PPO health insurance plan.

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