I thought I had my psoriasis licked. I was taking Raptiva, a medication I inject myself once a week. After taking it for two months, my hands were finally clear of psoriasis. It was in full remission.  It felt so good to have normal hands for a change.  I felt like a normal human being. No pain, no thick scaly areas, no cracks, no bleeding.

It was great.

All that changed when my former primary care doctor withheld a referral to continue seeing my dermatologist. When he originally referred me to see my dermatologist, he wrote a referral for 20 visits. Unbeknown to me, my insurance company refused to honor the referral for 20 visits. They required a new referral after every four visits.  I never knew this.  My dermatologist was contacting my doctor after every four visits to get another referral faxed to them.

To the best of my knowledge, the initial referral for 20 visits was still in effect.

When I arrived at the dermatologist’s for my appointment to gauge the success of the Raptiva, the person at the front counter asked me for my referral.  She proceeded to tell me about needing a new referral after every four visits and that my doctor said he would no longer issue a referral over the phone.  From now on, he would only issue them in person.  She told me that someone from my doctor’s office should have contacted me and told me this.

Nobody bothered to tell me.

This meant I could not be seen by my dermatologist.  This meant I could not continue taking the Raptiva.  I needed another prescription if I wanted to continue taking it.  That’s something I could not get without seeing my dermatologist.

I immediately went about looking for new doctor.  One that wouldn’t screw me over like that.  By the time I found one taking new patients and got an appointment to be seen and got a new referral to see my dermatologist, the psoriasis was back.  If anything, it was worse then ever.

I don’t understand why I need a referral to see a dermatologist. Psoriasis is a life long, chronic condition that I will have for the rest of my life. Seeing a dermatologist is something I will be required to do for the rest of my life. My insurance company knows this.

By requiring me to get a referral from my doctor, they are in a sense having him re-diagnose my psoriasis.  That’s something he is not qualified to do. If he was skilled and knowledgeable enough to diagnose psoriasis, he would be skilled and knowledgeable enough to treat psoriasis and I would not need to see a dermatologist.

It’s middle-man medicine.  Putting my primary care doctor in the process adds absolutely no value. It doesn’t make for better care.  All it does is drive the cost up.  By requiring me to come in and be seen every time I needed a referral, he gets to charge me a $30 co-pay along with whatever he bills my insurance.  It becomes an unnecessary obstacle to receiving quality medical care.