I just called to schedule my annual appointment with my dermatologist that I have seen for several years. I was informed that – due to Obamacare – I needed a referral from my primary care physician before I can see my dermatologist. So, I called my primary care physician to find out I have to go there, I can’t get in for four weeks, and I will have to pay a co-pay for the visit.

SERIOUSLY!!! I thought this was healthcare REFORM???? Something that is (1) delaying the real appointment I need, (2) costing me time away from work for a primary care appointment I DONT NEED, and (3) costing me more money……..please explain how this is reform? I am absolutely disgusted about this!!!


Answer

In a Health Maintenance Organization (HMO) you'll typically need a referral from a primary care physician (PCP) to see (PCP) to see a specialist like a dermatologist.

Your PCP coordinates your care. One of the ways an HMO keeps costs down is by having a focused network and using PCP referrals. The long wait times are due to the demand for your dermatologist, now more people can see them. Copays are a way of keeping premium costs down. Generally, the more popular and more affordable plans got a lot of sign ups. So the networks that participate in those plans can tend to be a little over-booked. This should become less of a problem as supply of doctors reaches to meet the demand of policy holders.

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Richard Brahman on

bureaucracy wins

Bray W. on

Im 19. I have sever psoriasis, yet i have to wait 2 months before my pcp will see me- then im assuming it will be another 3 week wait after i get a referral to a dermatologist before i can see them. as for universal health care, please tell me that my situation isn’t flawed. please tell me “obamacare” isn’t flawed. please tell me that i will live to see age 20 because if this is the health care im going to be receiving, i might as well go to medical school myself so i don’t have to wait months on inept health care providers to prescribe me a simple ointment or steroid that will help my condition.

Unhappy skin health patient on

Dumb healthcare policy. This is one circumstance you could be proud that you are not an American. You can see a dermatologist easily outside US.

Joey on

> The long wait times are due to the demand for your dermatologist

So instead we have long wait times for a PCP (because everybody has to go through them to get the referral to the specialist they already know they need. And then we pay that PCP to TELL us that we need to see X specialist, which we already knew in the first place.

Christ. Just a admit your whole industry’s a racket, that you’ve got the country by the short hairs, and there’s nothing we can do about it. Knock off this “it’s for your own good” nonsense.

SHARON on

(33) Notwithstanding any provision of this section to the contrary, a health maintenance organization which offers dermatological services shall provide direct patient access, for office visits and minor procedures and testing, to a dermatologist who is under contract with the health maintenance organization. The term “direct patient access” means the ability of a subscriber to obtain such services without a referral or other authorization before receiving services. The health maintenance organization shall, by July 1, 1997, develop criteria for compliance with the provisions of this subsection which do not impede or inhibit access to dermatological services for policyholders of the health maintenance organization. The criteria may include a maximum of five office visits to a dermatologist without prior authorization for a dermatologic problem within a 12-month period. *STATE MANDATE FOR DERMATOLOGY NO REFERRAL REQD *

sonia mac on

The “answer” provided does not answer his rhetorical question. He should not have to go to a primary physician again if he was already referred to his current dermatologist in the past.
He is asking why his medical record is being “reset”, as if he is wanting to go to a dermatologist for the first time.
Your answer was “because the new system is as circular as my answer”.

ObamaCareFacts.com on

I get it. So referrals and new patients work differently. I’m not sure why he was told he needed to do this. My assumption was that with the new plan and new rules it needed to be schedule this way. A better answer would be, contact your insurer for an explanation, since this is in fine print territory and i’m not sure of an exact answer.

Zachary z on

Just seen a doctor at the E.R about a week. Ago about a black spot on my foot concerned that it is Melanoma skin cancer now they told me to get a PCP then be reffered to a dermatologist now I already tried the ER thing and followed there instructions to get a PCP and cannot find a PCP I already called multiple offices and left voicemails nobody has returned a call wtf do i do serious medical concern no PCP can I just walk in to a dermatologist office and have them cut it out

Zachary on

Just seen a doctor at the E.R about a week. Ago about a black spot on my foot concerned that it is Melanoma skin cancer now they told me to get a PCP then be reffered to a dermatologist now I already tried the ER thing and followed there instructions to get a PCP and cannot find a PCP I already called multiple offices and left voicemails nobody has returned a call wtf do i do serious medical concern no PCP can I just walk in to a dermatologist office and have them cut it out

Dez Nutz on

Shut the fuck up all you bad skin having racist. The only reason you have health insurance is because of Obama. Before that no one would accept you with your terrible preconditions or you flooded the county hospitals. Go see a Russian doctor, I’m sure there’s no wait, itchy ass!

Chrystal G Lee on

My understanding, however, particularly, IN THE STATE OF FLORIDA,is that you DO NOT need a referral to see your dermatologist. Other specialist, yes, dermatology, no . If you participate in an HMO plan, you do, normally, need to get a referral from your primary care to see a specialist. If you have a PPO plan, you do not need to get a referral from your primary care doctor to see a specialist. Or, if you have what they call original Medicare (with or without a supplemental insurance plan) you, also, do not need a referral from your PCP to go to a specialist.

Liberals suck on

My health coverage was affordable and actually worked prior to obamacare. My insurance today (2018) is now almost unaffordable and covers things I will never use.

Why did the liberals screw things up so badly just so 1% of the population could get free insurance?

ObamaCareFacts.com on

That is an overly simple take on the matter. Tens of millions were without coverage prior to the ACA, the steps taken to insure them, combined with all resistance, combined with the rising cost of healthcare in general, resulted in higher prices. There are lots of problems, some of those problems are things we can rightly hold liberals responsible for… but the healthcare crisis extends well beyond party lines. You’ll notice that the GOP hasn’t magically fixed our healthcare system, that is your first hint it isn’t “just liberals.”

tae on

so I live in the state of Colorado, I recently went to see a dermatologist because I have severe eczema. Had I known, which I didn’t that you needed a referral. So I called ahead to see if I could get in to see my primary doctor, they proceeded to tell me that it would be two months before I could get in. given this information I wasn’t ok with, I thought to go to an urgent care provider for my referral, called ahead and all. Got my check up and referral. Here’s where I start to get pissed off, I call to make my dermatologist appointment with my referral and they ask do I have a referral, ” yes” I said yes, right? they tell me they’re going to transfer me to a primary care provider, this lady then asks again do you have a referral. you know what I said. she proceeds to ask if it’s on paper or did the doc send it in. It is paper. SO she says you can either fax it or make another appointment with your primary care provider at your general hospital and get another referral,( in another month) and hope the dermatologist can fit me in. what is this flawed system?

ObamaCareFacts.com on

Some types of plans require referrals to see specialists. The logic is it is supposed to keep costs down by having a primary doctor who knows the patient see them first and then approve the specialist (confirming if it is needed). It isn’t actually a system that relates to the ACA, it is simply a system used by health insurance companies.

James LaForest on

I would like to see a dermatologist to test me for skin cancer, and other possible skin damage.
I have Medicaid through Meridian health care.
Do I need a referral?
Thank You
Mr. James LaForest

ObamaCareFacts.com on

In general you do need referrals for specific treatments and tests, since that is true the best first step would likely be to ask your Primary Care Provider (PCP), you can also check with your insurer.