How my former primary care doctor screwed me over

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.

Author: Bentcorner

This is my personal blog. It's where I write about things when I feel like it.

18 thoughts on “How my former primary care doctor screwed me over”

  1. I’d put the blame in the title towards your insurance, rather than the doctor. Then again, most people would see “insurance screwed me over” and go, “no, really? Never heard that happen before!” 😉

    But, yeah, having a well-defined chronic illness should allow for seeing a specialist indefinitely without continual referrals. Have you tried to haggle this out with the insurance?

  2. No, I put all the blame on my former doctor. He was the one that pulled the dick move of requiring me to come in and be seen for another referral to my dermatologist. He just never bothered to let me know. I didn’t find out until I had taken a half-day off from work and drove down to West Virginia to see my dermatologist.

    He had already referred me for 20 visits. He was on my 16th visit. He should at the very least followed through with the intent of the original 20 visits.

    The only reason he did this was to make money with a needless office visit. It wasn’t to provide any type of medical care.

  3. I don’t know, Rick. I think your doctor wanted to give you the 20 authorized visits at once. Your HMO’s policy of requiring authorization every 4 visits puts an administrative strain on his office that can be a distinct nuisance that he’s not compensated for at all.

    While they should have contacted you, I think the decision to require the visit is more aimed at your HMO than you as a patient. Look at your next insurance statement to see how many charges they deny from your doctor. Forcing some compensation from their inane need for him to authorize every 4 visits becomes more understandable.

  4. Rickistrative strain? He withheld the referral without even telling me. He wasn’t trying to improve my level of care, he was only trying to pad his bottom line.

  5. Never said he was trying to improve your level of care, sir. Said he was more in a fight with the HMO for money than trying to screw you over for your co-pay cash.

    Rickistrative strain? Derm office calls primary office. Rickistrative assistants or nurses communicate with each other about the need for a referral. AA or LPN has to consult doctor or records re: referral and then call the derm office back.

    Having suffered from a pharmacy needing to confirm prescription info with a doctor, the phone tag that ensues can take several attempts of communicating that phones for setting appointments or taking new patient calls. All because your HMO won’t accept your doctor’s long term referral.

    Again, primary doc office sucks ass for not notifying you. I’m just taking the devil’s advocate role on why your doctor might have had less evil reasoning.

  6. You are making my point. He’s not interested in improving my level of medical care. He is only trying to get more money from my insurance company. A doctor has a moral and professional responsibility to do no harm to his patient. By withholding a referral he knew I needed, he was doing just that. And for what, so he could bilk my insurance company for some extra money?

    My former doctor is not evil. He’s just an incompetent, unethical dick.

  7. I think both the doctor and the insurance company are at fault.

    The doctor is an asshole for not notifying you about the referral situation.

    The insurance company is shitty for requiring a referral in the first goddamn place.

  8. I agree with Schooly.

    What I might have done a bad job of expressing is that the insurance company basically expects your doctor to reassess the situation every four visits and decide whether to still refer you. The doctors are trying to circumvent that to make it easier on you, but now it appears your PCP has tired of the hoops the HMO makes him jump through.

    The failure to notify you might have been an administrative oversight by the people in his office he trusts to contact his patients. IF they had notified you in a timely fashion, he’d have kept to the “do no harm”. The change to requiring a visit to renew the referral isn’t a harmful decision in and of itself.

  9. The change to requiring a visit to renew the referral isn’t a harmful decision in and of itself.

    Well, I’ll certainly try to remember that because from where I’m sitting, by requiring me to make an office visit before he would issue a referral and then NOT telling me this fact, my treatment was delayed for two months which resulted in a massive flare up.

  10. I appreciate how this is such a personally frustrating thing, but try to stay with what I said. THE CHANGE TO REQUIRING A VISIT isn’t something that does harm. Jesus, Rick, the sentence before what you selectively quoted spells out the distinction:

    IF they had notified you in a timely fashion, he’d have kept to the “do no harm”.

    I acknowledge that what actually happened to you wound up doing harm. I’m just saying the requirement for an office visit wouldn’t have been something that violated the “do no harm” concept if they followed through with a notification.

  11. I appreciate how this is such a personally frustrating thing, but try to stay with what I said. THE CHANGE TO REQUIRING A VISIT isn’t something that does harm. Jesus, Rick, the sentence before what you selectively quoted spells out the distinction:

    IF they had notified you in a timely fashion, he’d have kept to the “do no harm”.

    Try to stay with what you said? Talking down to me isn’t going to make me think you are right about this, because you’re wrong. You are trying so hard as you said earlier to play the devil’s advocate that you are arguing the absurd.

    There was no medical reason for me to make an appointment with my primary care physician. There was nothing he could do as a primary care physician that would improve my health or well being. It would be an unnecessary medical procedure for the sole purpose of billing my health insurance and charging me a $30 co-pay.

    You keep on saying “IF he had notified me”. The fact of the matter is that he didn’t notify me. I’m dealing with what happened, not what might have happened.

    And as far as selectively quoting you is concerned, I did no such thing. I quoted the entire sentence.

  12. Rick, you tried to paint what I said earlier as saying that, even with the failure to notify, the requirement of the appointment did no harm. I had a sentence that specifically said that wasn’t the case. Talking down to you? If you were reading everything I wrote, then you were purposely twisting what I said into something else. Forgive me for thinking that you skimmed and missed rather than deciding to be pissy at me for something I didn’t say.

    You didn’t selectively quote me? You ignored the prior sentence that specifically acknowledge that the failure to notify you fucked it all up and made it that he screwed up the “do no harm”.

    Again, you kinda miss the point that the reason the HMO requires the doctor to give a referral every four times is because they expect the doctor to reassess the situation every four times. Requiring an appointment is just finally giving in to the way the HMO was looking for it to be done. Requiring an appointment does no harm if the patient is aware of it. I’m sure the lack of a notification wasn’t part of the office’s plan, but just a fuck up.

  13. “the reason the HMO requires the doctor to give a referral every four times is because they expect the doctor to reassess the situation every four times. Requiring an appointment is just finally giving in to the way the HMO was looking for it to be done.”

    I seriously doubt that this is the reason. I’m SURE that the issue is totally and completely monetary. The doctors want to make sure the cash gets spread around as liberally as possible. For a persistent and ongoing condition, it would be ridiculous for a referral to be necessary every four times.

    I had a doctor once who made me come in for a doctor’s visit every 3 months, when I needed a new prescription for allergy medication. The medication is now over the counter and practically has no side-effects. She just wanted to bilk the insurance company. I finally got a new doctor and he gives me a year’s worth of allergy prescription (or calls it in when I alert him I need a new one.)

    My point is that doctors and insurance companies don’t really give a shit about anyone’s health.

  14. I definitely agree on the insurance companies and the one doctor you described, Schooly. But that doctor doesn’t seem to have an annoying insurance requirement on the prescription thing, while the doctor in Rick’s case did. Still, you might be right about that guy, too. It’s just not definite one way or the other.

  15. Kevin, you know everything there is to know about my experience with my former primary care physician and you know the inner workings of my health insurance plan. Heck, I didn’t even know it was an HMO until you said it was. I always thought it was a PPO. You say it’s an HMO so that’s what it has to be. Even though you don’t know my former primary care physician, you know exactly why he did the things he did and you are able to vigorously defend his actions.

    The only reason I blogged about this was that I thought it was important to share my experience with other people, people that might have had similar experiences. It wasn’t so somebody who knew nothing about the particulars could come here and play “devil’s advocate” and argue about things they knew nothing about.

    Please go do it somewhere else. I’ve had my fill.

  16. Rick, I took a guess at HMO, since they tend to be more restrictive about stuff. I’ve not tried to tell you authoritatively why the guy did what he did. I haven’t tried to tell you what your experiences have been.

    What I did say is that requiring an appointment for the referral isn’t a violation of “do no harm” by itself. Which you answered by suggesting I said that requiring the appointment AND failing to let you know did “no harm”, despite my clearly stating that failing to notify you caused harm.

    Sorry to upset you. I had no idea that you post blogs with open comments but expect no one to post an opinion, give input or correct you when you willfully twist their words. Clearly, the fault is mine.

  17. I had a doctor once who made me come in for a doctor’s visit every 3 months, when I needed a new prescription for allergy medication. The medication is now over the counter and practically has no side-effects. She just wanted to bilk the insurance company.

    That’s the thing. I already had to go in every three months for something else. Having to go in every time I needed another referral to my dermatologist was to be in addition to going in every three months for something else.

    I called my insurance company and spoke to them about it. They told me that he should have submitted something called a “standing referral”. It’s for patients with chronic, ongoing conditions and they are good for a whole year.

  18. Sorry to upset you. I had no idea that you post blogs with open comments but expect no one to post an opinion, give input or correct you when you willfully twist their words. Clearly, the fault is mine.

    I think I finally understand what so many other people see in you Kevin. There’s a reason you’ve been banned from message boards and not allowed to post comments on other people’s blogs. Please add this blog to the list of blogs where your opinion is not welcome.

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