My Nemesis: HMO of PCP?

Just cancelled the OR booked for tomorrow’s procedure because my Primary Care Physician, PCP, wants me to see someone he is affiliated with that “might be a solid choice” instead of the one suggested by one of my specialists.  I have two health insurance plans and both approve my choice of surgeon and hospital, but my PCP will not sign a referral.  I cannot put into words how completely frustrated I am right now.

I spoke with my primary insurance provider and explained that I felt this was a conflict of interest; where was the PCP’s allegiance to his patient or the company signing his checks was my point.  Especially if the doctor I found has more experience and a better reputation than someone he looked up in his company’s directory and he doesn’t even know. How is this the best care?  That is why the HMO is designed this way, to give you the best quality and continuity of care. 

My PCP could have signed the referral and I could be at Brigham and Women’s tomorrow getting this resolved, instead I have to wait until the middle of November to see a doctor in Wellesley for a consultation and start the whole process over.  This means I will not be well enough to return to Aquatic PT until early next year, which will be a total of about nine months missed.  This means I have to start that recovery process over again as well.

After discussing this with the insurance company I learned my only recourse is to fire my PCP and choose a new one. 

I cannot help but think, is this a personal reaction on his part because he felt “left out of the loop on this one” or is this really him towing the company line.  Either way if one were to consider the patient’s best interest here, I would be done tomorrow and back in the pool in four weeks.  That being said, can I really continue to receive care from this physician?  As I consider our history together I am carefully examining each decision over the past several years.  Is this the first time he failed me?  Does that even matter if he knowingly put my health, my walking, to the side to maintain company affiliation?

Severing ties means saying goodbye to my providers affiliated with this PCP and his company.  This system of health care is exasperating!  In the field of community based mental health services, treatment is client-driven because they know its value.  I should be able to choose my own providers given my vast array of medical professionals.  If one of these providers (particularly one who performs surgeries themselves) makes a recommendation for a known entity to treat me, versus my PCP having to look someone up in a directory, I believe that should suffice.  Unfortunately no one asked me because they do not care what I think, so I must move on.

I will start by doing research on a new Primary Care Physician.  When control is taken away from us, whether real or perceived, we need to take steps to empower ourselves.  So I will make a list, do the research, and interview the best candidate.

Taking steps to take control back establishes confidence and allows us to focus on the tasks instead of the overwhelming feeling of being at the mercy of others.  When you cannot choose your surgeon you definitely feel powerless and that is no way to start any medical recovery process.  Therefore I need to regain my confidence before I have my new PCP refer me back to the surgeon I chose.  I am hoping that finding someone I am comfortable with will do the trick.

~Wish me luck!