I Need to Change My Mind-set

We’ve had an HMO (through a Health Maintenance Organization) insurance plan for several years.  With a HMO, you choose your Primary Care Provider (doctor) who acts like a “gatekeeper” for all your healthcare needs.  This means that you must get permission from your PCP before you can see any specialists.  (Of course there are always a few exceptions to the rules.)  For example, if you feel you need a dermatologist, you either have to see your PCP, or you may be able to call his or her office and he or she will agree to set up a referral without seeing you first.  Either way, you just can’t just make an appointment with the dermatologist before following the correct steps.  The first of this year we changed from an HMO to a PPO (Preferred Plan Organization). We don’t need our PCP to refer us anymore.  If something urgent comes up that we feel we need to see a specialist about, we can call the specialist ourselves and make our own appointment.  No longer do we need to get “permission” from our PCP.  Now here’s where I need to change my mind-set.  My husband noticed a lump where it didn’t belong.  We automatically resorted to our “old way of thinking” and called his PCP to be seen.  Originally he didn’t have anything for a couple weeks out, but he did eventually get him in within a day.  Had he not been able to see him for a couple of weeks, we could have just bypassed his PCP altogether and called a specialist for an appointment.  Now granted with our PPO, we can refer ourselves and make our own appointments, but there are still specialists that won’t see you without a referral or recommendation from your PCP.  This has nothing to do with the way your PPO insurance works; it just has to do with the specialist’s policies and procedures.  We’re still working on my husband’s condition, and now if we feel if we aren’t satisfied with his PCP’s treatment, we can self-refer him elsewhere.  Important Note: When self-referring, make sure the specialist is a PPO Plan Provider with your insurance.