She has aged out of pediatrician's office

Parent Cafe
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<p>The way the HMO works (or did the last time I checked) is that the primary doctor is responsible for some of the fees charged by a specialist. The pediatrician will not write a referral that he is partly financially responsible for (cannot blame him one bit) and since he is no longer receiving his monthly fee from the insurance company he is not the doctor of record and the HMO would not honor his referral for their part of the specialist’s fee. It will all work out after this one visit. I hope she likes this new doctor and we do not have to got through this a second time.</p>

<p>I thought I read somewhere that 19 is the recommended age if a girl is not active.</p>

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<p>Ahh, shucks. I was hoping we could just avoid this whole topic! haha You are right of course, corranged and idmom… When I looked back on my own history, my mother took me before I went off to college. It’s just, geez, I want to put THAT off!</p>

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<p>While neither one of mine asked to see the gyne (after all, what 18-year old WANTS her first pelvic exam?), once D1 got to school and saw all the girls on the pill and how much it helped to regulate their periods, the cramps, the number of days, AND help with any acne problems, she did vaguely suggest she would be willing to do the exam if she could get the pill.</p>

<p>D2 has only been at school less than eight weeks, and has not said anything. She won’t be home until Thanksgiving, and I know she doesn’t want to spend a minute of that time in a doctor’s office, so I don’t expect any gyne appt. requests until at least Christmas break, if then. She had some rather miserable experiences this summer with immunizations, wisdom teeth, etc. and would just as soon not go anywhere an office that smells of antiseptic.</p>

<p>They will both be due for their third HPV vaccines over Christmas break, though, but that’s just a nurse visit.</p>

<p>Don’t forget - these kids have student health centers at their schools, and if they become sexually active after they leave home, and are smart enough to deal with it, then they can go there for an appointment. </p>

<p>Cmbmom - perhaps if your daughter has a ‘complaint’ she can go into the visit with, they will code the visit so it’s not a physical. Really, if he/she spends more time on the visit addressing a complaint, then it really could be a ‘non-physical’ visit. I wouldn’t give up yet.</p>

<p>This reminds me, when I had to get D’s physical prior to college, the insurance company itself told me how to ask the doctor’s office to code the visit because they wouldn’t cover a college-physical visit, but they would cover a well-person check-up. It’s crazy.</p>

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<p>Neither of my Ds wanted to continue seeing the pediatrician along with all of the little kids and babies. I think it’s a good time to transition away from a pediatrician anyway.</p>

<p>cmbmom:
This Catch-22 problem seems to have been created by the rules of the HMO. Given that, if you explain the issue to them it seems that they should be able to offer a solution such as covering the phys exam anyway or allowing the referral to a specialist to occur anyway.</p>

<p>Maybe consider going with a PPO rather than an HMO at the next switch opportunity for more flexibility in the future.</p>

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<p>My son can continue to see his pediatrician through college. She even went to see his HS plays!</p>

<p>I think the Edible Arrangements sounds great.</p>

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<p>Did you speak to the pediatrician or the staff?? Frankly, it seems a bit unethical for him/her to refuse to care for a patient. I wonder if the doctor knows?</p>

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<p>Well gee, she has some issue she needs a referral for. Can’t she go see the new doc for the issue – and then get the referral? Won’t that work?</p>

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<p>It might help ease the scheduling demons if you have that physical appointment on the books, on whatever date the HMO will next pay, with the new doctor. In my HMO the physicals are often scheduled 8 months out, regardless. Then the ‘interim’ appointment with the new Dr. for the issue at hand might be more acceptable. </p>

<p>The hoops we jump through…</p>

<p>My son appreciated having his pediatrician all through college, good continuity in a time of flux. We love this guy and his good sense, When I asked about future care while he was still in HS, the pediatrician said it minimizes falling away from the health care system entirely in young adulthood, as some might tend to do. But the sight of my son’s long hairy legs and toes just don’t fit in that office with Sesame Street posters and toddlers running around!</p>

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<p>The pediatric pulmonologist (affiliated with an academic institution) my D sees for her asthma continues to see patients into their late 20s, and said he has a couple in their 30s. When you find someone good, it’s hard to let go!</p>

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<p>CNP, the problem is that the new doctor requires a full physical for new patients, which is a normal practice. The HMO, on the other hand, won’t pay for the doctor-required physical since it has been under a year since his last physical with his pediatrician. This is also a normal practice. The abnormal practice is the fact that the son’s pediatrician’s office for some reason refuses to see him, even if it’s just to give him a referral.</p>

<p>I agree with trying again with the pediatrician’s office, if possible. A referral can often be done without ever going into the office. Ask to leave a message for the doctor himself explaining the situation, if you can. If that doesn’t work, call the HMO people.</p>