Navigating the World of Managed Care
Many individuals do not know do not know where to turn when find
out that they suffer from diabetes. In desperation, they look for an
answer by reading books, surfing the Internet for information, and
visiting numerous doctors who have varying opinions about the
management of diabetes. The search often leads to an improper
diagnosis or just to a dead end.
There are many compassionate physicians who will be able to help you
understand the dietary,lifestyle and nuutritional changes you must
changes a diagnosis of diabetes brings about. As a patient, your
physical and emotional needs must be taken into consideration every
step of the way. If you have opted to join an HMO, Medicare HMO or
Medicaid HMO, you are required to pick a primary care physician on
the panel. Physicians have different amounts of experience in caring
for older adults. Some lack the specialized skills and knowledge
needed to diagnose and treat patients with diabetes. Although these
plans are more economical than the Federal Medicare Program, you are
restricted to seeing a physician on the panel.
A caregiver asks a very important question: My husband suffers from
uncontrolled type 2 diabetes. Our primary care provider has not
offered to refer my husband to an endocrinologist . If we are
members of an HMO, how do we obtain referrals for these specialists
in our network?
Use your provider directory to choose a provider who meets your
geographic and medical needs. Draft a letter making a formal written
request for a referral to the specialist you have chosen from the
panel. Send a copy of your request to your primary care provider and
send a copy of the letter to the Medical Director of the HMO.
His/her contact information should be listed in your provider
directory or should be available to you by calling the HMO’s
customer service number.
A patient shares an important concern: I was able to get a referral
from my primary care physician, but the receptionist at the
specialist’s office says the next available appointment is not for
several weeks.
Once a referral is provided, it may take weeks or months before you
can actually see the doctor. If this happens to you, you should not
give up! Send a letter to the HMO’s Medical Director. A letter of
concern can be very powerful, especially if it gets to the leader of
an organization. A sample letter is provided below:
Sample Letter
Date
Your address
Phone number
Name of HMO’s Medical director
Address
Dear _________:
This letter is to formally notify you of my (concerns or
dissatisfaction) with the length of time before accessing the urgent
medical care needed by (person’s name and social security or member
#). (I, my husband, my wife etc) saw Dr. (primary care physician’s
name)