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not HCM related question but had to get this off my chest!

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cynthiaG Find out more about cynthiaG
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  • not HCM related question but had to get this off my chest!

    I was diagnosed with a sliding hiatal hernia a month ago...been having upset stomach occasionally and heartburn...(see my post in the medication section). I have Blue Cross/Blue Shield HMO Blue in which you have to have your PCP make a "referral" if you want to see a specialist. I called my PCP's office and the nurse called me back and told me that she contacted a gastroenterologist and that office told her to tell me to see a gastro surgeon ...WHY?? don't I have a right to see a gastroenterologist and be checked out and see what he or she recommends??? I was floored!! I'm getting out my Blue Cross/Blue shield Provider book and finding one in Boston....it's only 40 min. away and they have the best of the best there. I'm making the phone call, not my PCP's office.
    \"It is not length of life, but depth of life.\"

    Ralph Waldo Emerson

  • #2
    I think you are 100% correct to see a 'generalist' with training in your area of problem (regardless of the field of specialty - cardiac, gastro,) and the same applies to HCM - if you go to someone who specializes in a particular procedure you have a much higher likelyhood of needed just what that doc can offer. We have seen this many times here at the HCMA with such issues as ablation, ICD's and myectomy. That is why it is important to have a doctor look at the whole you and offer ALL options.

    Good luck,
    Lisa
    Knowledge is power ... Stay informed!
    YOU can make a difference - all you have to do is try!

    Dx age 12 current age 46 and counting!
    lost: 5 family members to HCM (SCD, Stroke, CHF)
    Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
    Therapy - ICD (implanted 97, 01, 04 and 11, medication
    Currently not obstructed
    Complications - unnecessary pacemaker and stroke (unrelated to each other)

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    • #3
      Cynthia

      I have the same insurance as you and i would think that the insurance company would not pay for a surgeon before a gastro doc sees you, i mean it may be something you can live with here with proper meds my mother had a hienal hernia and she was never operated on they said only if it grew or meds did not work, i hope you get to the bottom of this, i would talk to your PCP doc and just tell him what you want they have to let you make that decission

      Shirley
      Diagnosed 2003
      Myectomy 2-23-2004
      Husband: Ken
      Son: John diagnosed 2004
      Daughter: Janet (free of HCM)

      Grandchildren: Drew 15,Aaron 13,Karen 9,Connor 9

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      • #4
        Hi Cynthia,
        I too have an HMO where my PCP must initiate all referrals for almost every specialty, but I work things a bit differently.

        Sure, the normal routine of seeing the PCP and having her indicate who I should see and then making the referral is in place and is working fine, but then there is traffic the other way too.

        I will write a letter and fax it to the PCP explaining what the problem is, and who I want a referral to because of it. I will sometimes go so far as to check the in-plan provider lists and tell the PCP exactly who I want to see. I have never been refused by the PCP. Sometimes I get into a hassle with the insurance company – especially when I request a doctor who is a particular specialist, but is not an HMO provider. Sometimes I win those and sometimes not, but overall I think things have worked out reasonably well.

        Why not tell your PCP who you want a referral to – and see if he/she follows through. It might be as simple as that.
        Burt

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        • #5
          Thanks....I plan on calling a few gastroenterologists at NEMC and then requesting the referral from my PCP. I'm not having them choose. I'm telling the nurse that the office making only one phone call to one gasto and telling me to see a surgeon is not acceptable. I will choose and request the PCP referral.
          \"It is not length of life, but depth of life.\"

          Ralph Waldo Emerson

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          • #6
            an update:

            I have an appt. with a gastroenterologist on Monday..I had no problem this time...I spoke with a different nurse in his office
            \"It is not length of life, but depth of life.\"

            Ralph Waldo Emerson

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