<p>MaineLonghorn, As they say, your mileage will vary. </p>
<p>I know people who are very happy with their plans through Maine Community Health Options. They are a provider run coop with startup funds from an ACA grant and very committed to patient care. Anthem is, in my experience, a soulless insurance company that you have to argue with multiple times.</p>
<p>Tatin, and I think most people who had insurance before will purchase insurance. JMO, but buying something which can save you from going into financial ruin is different than buying a new iPhone or the latest must have gadget because of the cost.</p>
<p>Ps: I hate auto correct!!!</p>
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It probably depends somewhat on the doctor. I’m finding that email has shifted the landscape somewhat --depending on whether or not a doctor is reading the email. Of course, that’s assuming you know who you want to see – without the referral, you are pretty much confronted with a list of random names — though I 've not always been particularly happy with the specialists I’ve been referred to either. </p>
<p>I’m not debating your underlying point. I just wanted to mention this because I don’t think you or anyone else should assume that that you need to depend on your primary doctor to get an appointment if your plan doesn’t require referrals. Particularly with a problem that seems to be unusual or hard to treat, a patient might simply want a second opinion. And sometimes it’s best to get that second opinion from someone who does not have a relationship with the referring doctor or with the specialist that doctor recommended.</p>
<p>The other change is digitalization of medical records – it creates a situation where the patient is often able to access and send their own medical records directly to the specialist, without having to depend on the primary doctor to forward them.</p>
<p>Calmon, of course I could call on my own but there is no way a specialist, if I call on a Thursday afternoon is going to give me an appointment for the following Monday morning. Not in the world I live in. The only way that would happen on my own is if I called one of my specialist friends. Unfortunately for me, none of them are urologists. Try calling a neurologist or a gastrologist or an endocrinologist, etc., etc., etc., without a referral or call from another doctor and see how quickly they will fit you in. The only quicker way is if you are admitted to the hospital and need to se a specialist. </p>
<p>Now, of course, I have a urologist, and if I ever need to be seen again, I will make my own appointment but that doesn’t mean i wouldn’t have to wait a week or two for an appointment, unless it was an emergency.</p>
<p>I’m not commenting on your situation. I’m making a general comment. I’ve gotten appointments way earlier than I ever thought possible when I’ve sent an email. Not “call” – email. </p>
<p>As to my primary doctor – I sent an email on Saturday morning at about 9 am to describe a problem - I basically wanted to know whether it could wait Monday. My doctor called me and told me she would meet me at her office at 11am that day. Her office is not open on weekends – but based on what was in my email, she was willing to do that. </p>
<p>I also wanted a 2nd opinion and consult from a periodontist last summer – I asked my dentist to send me the digital xrays, and I had the chart from periodontist #1 who had given me a recommendation I didn’t like. I had done some research and figured out who I thought I wanted to see; I sent an email at with the subject “consultation requested” summarizing my situation. The next day the doctor wrote back and asked me to send specific documentation – which I did. Then he arranged an appointment for me within a few weeks – even though when I called to schedule the appointment his staff said it would be several months to get a new patient appointment. (Basically the doctor bumped me ahead). </p>
<p>I’m not saying that would always happen and I’m not saying it would be faster than calling on a Thursday to get a Monday appointment – but I am saying that I have learned that EMAIL gets through in ways that phone calls don’t, in some circumstances. I haven’t had any situations yet where it didn’t work – mainly because I’ve only sent emails to doctors who have chosen to publish them. </p>
<p>Again, I’m not trying to debate with you – I’m trying to put out some information that could benefit others. You described a urinary tract issue and a long series of tests and procedures you went through before you got the referral to the urologist … and I’m kind of wondering why you weren’t referred to a urologist a lot sooner.</p>
<p>That is – you wrote that you spent 6 weeks getting tests for a UTI, Interstitial Cystitis, bladder cancer, etc., with multiple blood tests, cat scans, ultrasounds and a variety of different antibiotics. You are happy that at the end of all that, your doctor was able to get you a quick appointment at the urologist – but I am thinking that if I were in your position, I would have wanted to see the urologist in week #2. And I probably would have done some research on my own and sent an email if the option were available. </p>
<p>A patient with an HMO does need to depend on their PCP for a referral, but the rest of us don’t. And sometimes it’s a good idea to see a specialist sooner than later, rather than waiting until the PCP comes round to deciding that the specialist is in order. And my only point is that patients do have the option of arranging to see specialist or seeking a consultation for a 2nd opinion on their own.</p>
<p>Dovetailing with calmom’s post, there’s no question that being an informed, assertive (but not aggressive) patient, engaging in a dialogue with one’s PCP regarding desired & appropriate treatment, goes a long way towards being able to get that treatment, and getting it more expeditiously than being a passive recipient of care.</p>
<p>That said, all the research in the world won’t provide any benefit if one’s plan doesn’t facilitate or allow the treatment indicated by that research.</p>
<p>8885 is an interesting post for the reason that no one thinks in terms of emailing a doctor. I trade emails with many doctors but they are friends of mine and I am not their patient. 
I am not sure if any of them publish their emails professionally.</p>
<p>So throwing that question out there - how common is it to see an email for a doctor and is that normally for a practice answered by the people who take appointments or is it monitored personally by doctors?</p>
<p>I’ve corresponded beneficially with my PCP via email.</p>
<p>More recently, his hospital has implemented a secure messaging system, and we now correspond through that as a matter of course.</p>
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<p>You aren’t shouldering a particularly large burden. A lot of people with pre-existing conditions are going on Medicaid. And a lot of people who would have been uninsurable with pre-existing conditions pre-ACA were and are covered by their own or a family member’s employer insurance. </p>
<p>It’s just that previously, Medicaid was shouldering part of that burden, and employer-based insurance was shouldering part, and private insurance was only for healthy people. So now that there’s a level playing field, and you have to cover the treatment for sick people, just like people with employer-based insurance have always had to do, you don’t like it.</p>
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<p>Oh please. Make no mistake that people were shouldering people like me before (pre-existing conditions). The difference was that it was ER costs that were passed on when people didn’t pay. </p>
<p>Now, you’re shouldering the MUCH, MUCH cheaper preventative medicine (on a whole) for those conditions.</p>
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<p>We aren’t limited by our insurance plans if we want to get a consultation. (Useful for 2nd opinions). Yes, we may have to pay out of pocket for an out-of-network doctor, but a fee for a a consultation or review of patient records is not the sort of thing that will ordinarily break the bank. Of course it’s nice when the consulting doctor is in-network, but there are situations when an expert opinion is useful, especially if the condition seems to be baffling to the treating doctors and not responding to treatment. </p>
<p>Another situation where a second opinion by a qualified expert is where a particularly invasive treatment or surgery has been recommended, and the patient has reason to be unsure about the need or benefit for such surgery. That’s actually what prompted me to get the periodontal consult – in that case, I didn’t have dental insurance anyway, so it didn’t matter. But periodontist #1 recommended surgery that would have cost twice as much as what periodontist #2 charged to do endoscopy to achieve the same result in a more efficient and painless manner. (It just happens that there are only a handful of periodontists offering the endoscopy – hence I had to do my own research.)</p>
<p>But the point is: I think that it helps to get out of the mindset that we can only seek medical care of the insurance company will pay for it. Obviously, on the high end of costs, most of us don’t have the ability to pay extra. But a consultation might cost a few hundred dollars, and in some cases that few hundred out of pocket might save thousands – or at least save a lot in terms of the emotional toll. You don’t have to use the out-of-network consulting doctor to provide the recommended treatment – the point is to get another point of view added to the mix when one is warranted. </p>
<p>This is one reason I prefer to have a plan tied to an HSA - but the HSA is just a tax shelter for my own dollars. </p>
<p>I am probably a little more comfortable with this idea because of my legal background – I often had to hire and consult medical experts, sometimes as just a preliminary step before taking a case. Obviously, I was generally using experts who were in the business of providing legal consultation – but most also were active practitioners in their fields as well.</p>
<p>Texaspg, my doctor has separate emails listed on her web site to contact her or to schedule an appointment – appointments can also be scheduled by text. I assume that it’s a personal decision the doctor makes. Years ago when my son was a baby, his pediatrician had an early morning free call hour – it was the doctor’s personal phone and I think he would answer between 7 and 8 am – so that was the time to call if we had a question but weren’t sure whether or not we needed to bring the baby in. </p>
<p>I think the advantage for a doctor is a lot of issues can be resolved by email without a visit, and the doctor isn’t being interrupted. Doctors used to have medical switchboards that would answer the phone at all hours, but that seems to be a thing of the past – now all I ever get is voice mail, often at times when the office ought to be open for business. </p>
<p>My medical problem happened to be a UTI – the doctor prescribed Cipro, which knocked out the infection but I had a bad reaction to the drug and I was able to use email to report the problem to the doctor and get further advice. </p>
<p>But I probably wouldn’t choose a doctor based on whether or not they take patient’s email – it’s just a convenience for me and probably for the doctor, as it probably cuts down on unnecessary visits. (I’d note of course that I have never been charged money for an email – but a doctor with a busy practice might feel that it’s not worth the paperwork to charge for an office visit every time the patient has a question. )</p>
<p>I have two specialists that I mainly keep in touch with by email. One lives in our city and one lives 3500 miles from here. They are both fine with keeping posted on how I’m doing via email. The one in my city sees me about once a year. The one 3500 miles away I’ve been to 5 times for evaluations and follow up visits.</p>
<p>My internist does NOT do emails but is excellent and will return phone calls, especially if they are urgent. His office will also call in Rx as needed without seeing me between visits (I see him about 2-4x per year). My allergist I see only when necessary, which is about annually or sometimes more. My docs are all fine with me seeing whichever of them has an opening when I have an infection, since they are all busy and sometimes travel or are otherwise unavailable. I keep them informed about what the others have ordered or said and the system has been working well for the past 14 years.</p>
<p>I also have never been charged for my emails to my docs.</p>
<p>Our kids did have a pedi who had ‘sick kid’ visits before the ‘healthy kid’ visits. The wait would gobble up the entire morning with us waiting with our healthy kid who would ALWAYS catch whatever the sick kids brought in to the doc. We dropped that pedi & found one that didn’t do this to us & the kids.</p>
<p>I wish my internist did e-mail. He has a publicly accessible e-mail account but he admits he only checks it once every several weeks. He does sometimes want me to send him information by fax, but who faxes anymore?</p>
<p>Calmom, My gyno was going to send me to the uro sooner when he decided to have me tested for urea plasm. When it came back positive he decided to treat me with dioxycline - the antibiotic which in the end made me sicker. That wasted 7 business days, plus Xmas fell in between so I couldn’t get into see him again until the day after XMAS. That is when he decided I definitely needed to see the uro and got me the appt. for the following Monday. </p>
<p>The first two weeks were spent at my primary getting treated for the UTI I didn’t have and the second antibiotic I wasn’t finished with until the week after Thanksgiving. I then saw. They suggested I see my gyno next, which I did on Dec 2nd. The urine tests he did came up clean (those went to the lab so several days passes before i git the results. I was actually starting to feel a better when he decided to do the second test - which also took several days to get the results. By then it was Dec 18th and I was on the dioxycline for 7 days. </p>
<p>My primary suggested the next step was to see my gyno, so I did.</p>
<p>“So throwing that question out there - how common is it to see an email for a doctor and is that normally for a practice answered by the people who take appointments or is it monitored personally by doctors?”</p>
<p>We have a secure message system, and my doctor will answer my email within the day. She is a nice lady, but not a friend, so I suspect she does that for everyone. Probably way more efficient than people coming in to ask a question, or calling the office.</p>
<p>My doctor’s office believes that sending email violates HIPAA or something. So they have a stupid and annoying system where you have to log into some other system (and remember your password 
) to send and receive email-like messages. They’ll alert you on your real email account, but I hate the entire system and it’s horrible.</p>
<p>I only would have occasion to use this system every few months, so of course I forget my login id and my password. I hate it. I wish they’d just use real email.</p>
<p>BTW, I probably shouldn’t complain anymore about the outrageous premiums for narrow networks and limited formularies in the individual market. I now have group insurance with the identical network that I had with my previous non-grandfathered plan.</p>
<p>My primary and gyno are both in large practices and they don’t ever schedule there own appointments. When I need to speak to them I call the office and ask for the nurse line. The nurses then communicates with the doctor and then the nurse tells me to come in if its necessry or whatever the doctor wants me to do. If I feel I need to speak to my doctor personally, I ask and they call me back. I don’t think either of my doctors do anything by email, but tbh, I’ve never asked. I can get my results of lab work at my primary online, but I never do.</p>
<p>It may have a lot to do with the size of the practice. The doctors I mentioned sending email to are operating sole practices – my personal doctor only has part-time staff (or at least the posted office hours are less than full time). I wouldn’t expect to have the same relationship with a doctor who was part of a larger medical group – but then, I would expect the larger group to have other options like the nurse line emilybee mentioned. </p>
<p>There are other reasons why email - either direct or via an online system – can be very helpful. My son is divorced and there have always been communication issues with the ex-wife over medical instructions related to my grandson – for example, my son had a tough time getting his ex to tell him which vaccinations grandson had received. So things have always been easier at times when grandson was getting care from a facility that allowed parents to access that information online.</p>