Real Improvement

I live in America it's not very easy to do anything medically here. My only primary physician is an appointment doctor, and I scheduled one. I have access to another clinic that is cheap and easy but they don't give refferals. they removed my earwax twice.

For insurance purposes I have to get a referral to an ENT from a general doctor.

 

Is it the case that as a result of Obamacare, you can't choose your own primary physician?

 

This one actually doesn't have to do with Obama. I'm under a military medical system. Since my dad was in the military our medical coverage on base is very cheap. This coupled with insurance can get us an appointment at little to no cost. Problem is I only have access to that one clinic and that primary doctor. I tried my moms doctor but she had absolutely no idea what she was doing (She thought earwax was an ear infection).

 

You can choose a primary physician with Obamacare, if you're lucky enough to have any good doctors in your area that accept patients from it.

 

Not all physicians accept Obamacare? Also, is it the case that you can't have Obamacare pay for a physician you visit in another state?

 

I would stop the Flonase for a while, I have heard that you can get a rebound effect from using decongestants too often, and this can gum up the progress of cleaning the tubes out.

I'm getting a referral on Sunday, and going to a specialist at the end of next week, it's been three months and I'm still waking up to the same noise every single day, although the daytime and evening symptoms have improved somewhat.

I don't understand why your doctor won't give you a referral, mine has never refused to do it for any reason. Did you ask for a referral to a specific doctor you found, or for him to suggest one? If you can, do your own research and find one in your plan, and get the doc to refer you. I would suggest that it does not have to be an ENT, if you can find a specialist for Otology and/or the related fields of Neurotology and Otolaryngology. Good luck and keep us posted.

 

Wow I have been using them a lot. Thanks for the heads up.

 

Not everyone in the U.S. has government-sponsored insurance (aka Obamacare). There are many different private insurance companies in the U.S. and there are different plans, too, such as HMO or PPO.

HMO typically requires referrals before you can see a specialist — except of course in emergencies, such as if your appendix burst and you needed a surgeon. I think the rationale is that it reduces the number of patients that specialists see with minor problems that could be easily addressed by general doctors. For example, years ago I saw a pulmonologist for a pretty scary problem while the guy next to me in the waiting room mentioned he just had a cold that was making him cough.

PPO does not require referrals, or at least my PPO does not.

Medical facilities determine what insurance companies they will work with, and some may choose not to work with government plans. Often they will accept patients with insurance they do not work with, however that’s considered “out of network” so the amount the insurance will cover is lower. For example, once my family deductible is met, my insurance will cover 100 percent at any medical facility in network but only 50 percent at facilities out of network.

Regarding the ability to travel out of state for care, that’s the determination of the insurance company. My understanding is that some Obamacare plans do not cover out of state. It would be considered out of network, so you could see an out of state doctor but it would cost you more. And again, emergency life or death situations are different.

I apologize if you already know this! You’re very bright so you might, but I realize that it’s difficult on an international forum to understand how everyone’s insurance works. I thought maybe a very rough explanation would be helpful to others.

 

@threefirefour I agree with previous posters. Push for a referral. You shouldn’t need another appointment with your general doctor. Maybe just call and speak to a nurse. Tell them you’d like a referral and they will work with the doctor to get one for you.

I know it’s not easy, but you have to be your own health advocate. You’re pretty outspoken here (that’s a good thing) so I think you’ll do a good job pushing for yourself. And please know that being your own advocate and pushing doctors is not exclusive to tinnitus sufferers, I’ve had to do it with other conditions. Family members have had to do it with their cancer diagnosis, too.

 

I didn't know any of this. I keep hearing terms like HMO, and I always wanted to learn more about the system. Thank you!

In Canada people also need a referral from a family doctor in order to see a specialist. A family doctor will not be able to refer one to a specialist in another province.