Continuing the medical topic with Pammy

and yes, the goobenator did a lot of stuff to mess it and the rest of the state up…and "Moonbeam" is trying to get back in the game too, so you might as well write us off at the Sierras.   You’re lucky!  You got out of the once and proud golden state while you could!  Now it’s just a cesspool…

The HMO’s remain the same, but anyone living in a "rural" area, i.e., not Sacramento, the Bay Area, LA, San Diego, etc., all had to go on a PPO with all the BS (and I’m not talking bunny shins), that went came with it, especially with the higher $$$$ costs. 

I lived and worked in Chicago and we had a hospital insurance policy and had to get referrals for any specialist.  I saw a bone doc for knee pain and had the referral.  He wanted to give me a cortisone injection but couldn’t until I got another referral that said I could have one.

We later went to a PPO and we didn’t need referrals.  I moved to southeast Alabama in 2003 and was shocked at the healthcare down here.  I have to get a referral for everything no matter what insurance I have and even when I was paying out of my own pocket.  It’s the docs who won’t see anyone without being referred by someone else.  When I moved to a town 20 miles south of where I lived and my doc moved 30 miles north of there I switched doctors but had a hard time fining one to take me.  I have rheumatoid arthritis and get migraines.  A lot of docs won’t prescribe any pain meds.  I also have asthma,  hypertension, an underactive thyroid and diabetes.  Some said I was too complex for them. Then there were several practices that the docs didn’t admit or see patients at the hospital and I refuse to be in a hospital and not be treated by my attending.  I miss Chicago where I knew the docs by their first name and could call any of them and get an appointment on my own.

When I moved to Alabama I saw more nurse practitioners with offices than I ever did in Chicago.  Some are independent offices and some are in with doctors.  I see healthcare getting to the point where you have several nurse practitioners working for 1 doctor.  You go in and see the NP for routine checks and common colds.  They can prescribe meds and order tests so that would be no problem. If it’s something more complex then you’ll see the actual MD but that’s going to be rare.  More patients being able to be seen in a docs office and the doc doesn’t have to work as hard.  That may also be a way the government can save money since it shouldn’t cost as much seeing an NP as an MD.  

I’m not saying this is how it’s going to turn out but I can see it coming to that, especially with specialists.  Maybe you’ll see the specialist the initial visit then all follow-ups will be with the NP. 

Look at how it is now with OB’s.  A lot of the visits are the nurse who weighs you and takes your vitals.  You don’t see the doc with every visit.  At least that’s how a lot of them were in Chicago. 

In Alabama my husband was referred to a dermatologist for psoraisis.  It took 5 months to get an appointment.  Turns out there’s only 1 practice in this area with about 5 docs in the office but still a long time to get an appointment.  If they had NP’s you’d probably be able to get in a lot sooner. 

I do think the cost of a visit will go down if it turns out that way since the insurance or by that time the government won’t pay the same care for an NP as they do for a doctor.  But remember this is just my speculation and opinions.  With the government there’s no predicting what they’re going to do in any situation.