He's good, and if he doesn't feel he knows the solution, he send me to a specialist.

Here's why . . . The hours I work. It's as simple as that. I like that two years ago my company switched to allow a no referral option. This way - I don't HAVE to go to the Ob-Gyn for a referral to get a mammogram. . . I can just call and set up an appt direct. And then it's only ONE 2 hour slot out of the office.

For full time working people - it's kind of a blessing. The past few two it got me to a R.E. (skipped the b.s. at the Ob-Gyn and went right to the stork :lmao: ), dermatologist (bad hiving and rash issue), and a new Rheumy. My insurance also covers limited accupuncture so to not have to go to Wester Medicine to get Eastern Medicine care referral/approval is nice.

Oh and on each of those appointments - I didn't have to pay my Ob-Gyn or PCP the $25 first, take up their time, take time off from work, etc. etc.

One Co-Pay, one day time slot off from work - it's brilliant!

I get my scrip for my mammogram when I go for my yearly PCP physical. Then I go down the hall to the radiology lab and get the test. I now make an appt. for it right after my annual physical since I know in advance I'll have the scrip in hand. Then I go to the lab and get the routine bloodwork done.

I no longer need a Pap test each year so if I have a simple problem I have gone to my local Planned Parenthood clinic. I see a PA there and the care is wonderful. And yes, they accept Medicare!

I'm retired, but when I was working my insurance never covered acupuncture. The one time I tried it I had to pay out of pocket. I'm surprised to learn you have a policy that covers it!

As for rashes, my PCP diagnosed some skin issues I was having and advised me to use hypoallergenic soap products. Problem solved!

As I said, I'm luckily in pretty good shape physically. But in my experience it has HELPED me to confer with him first since I trust him to make a good judgment on whether I need a specialist.

My PCP is in a tiny practice with two other Osteopaths.

Then I have an Ob-Gyn.

Add in Ankylosing Spondylitis (Rheumatologist and Hematologist).

And a Reproductive Endocrinologist.

I get blood work about every other month, spine scans, hips . . .

Because of the risks to my eyes - I see an eye doctor (not a mall place) 2-3 times a year.

With the six physicians I'm in regular contact with - each asks me to participate in my health - they aren't "shufflers". They all originated from my PCP in 2006 (I still go to Danielle).

I love our insurance now (two years ago it sucked). When you live with an auto immune disease that women of color rarely get - not having people who really only know what they know stand in my way of getting to someone who knows something that can help is frustrating.

I follow a whole health approach (starts with nutrition) and have a team that supports that. And they all can communicate - each one has an electronic system that communicates with each other. When I developed pneumonia in September with MRSA - my Rheumy knew. We need much more of that - especially those of us that choose to live prescription free unless it's for an infection.

The big money saver - is Tablets. For the patients, the physicians, etc etc

so many health issues at one time. You certainly need specialists to meet your needs and I'm glad you have so many good health providers. Believe me, I know I have been fortunate in not having the kinds of health issues you experience. It must certainly be a struggle for you and I wish you the best in getting whatever care you need!

Good luck, Gen. I will be thinking of you...take care...

About 4 or 5 years ago we switched from an employer PPO plan with Cigna to the same company's HMO plan, which requires referrals from one's primary care physician. The reason we did it was because it was during the time when deductibles and cost-sharing started going up and up. The HMO plan offered us access to our same doctors, but at a cheaper premium price, and with NO deductibles and 100% coverage for hospitalizations and procedures in network. Since we live in an urban area with a wide network, it made sense to try.

So we have personally saved TONS of money by making this switch. It's a bit of a pain to have to go to your PCP to say, "I have this thing on my face that I think needs to be seen by a dermatologist," and he says, "you need to see the dermatologist." But considering the savings, it's not that much of a pain. And if this hadn't been a basal cell carcinoma that needed Moh's surgery (100% covered by our insurance), it would have been wasteful to see a specialist.

Whether we are saving money to the system is another question. We're the type who only go to the doctor when absolutely necessary (and have to be dragged then)--so I don't think we were overusing the system ever, and are capable of choosing our own specialist appointments. But many people want to see a specialist for every bump or hiccup, so overall, I think it's a good plan. Plus, there is a doctor coordinating all your care.

That is just yet another co-pay and hours spent waiting (they are never on time).

I do have a primary to monitor my hypertension and she is aware of the specialists I see. But do I think she knows as much about arthritis and current treatments as my rheumatogist? No way.

We pay quite a bit for our "no referral" policy and it is worth it in my mind.

at home every day faithfully, the only way I can stay out of pain. So I am probably lucky. But I am sure that if it were worse my PCP would be the first one to refer me to a rheumatologist! Why go if I don't need it?

I've had the same one for almost a decade, and she's a gem. She's the first doctor who hears whatever the problem is, then refers me out to the appropriate specialist. If we reach a point where the problem has migrated from acute to chronic (e.g., I'm in a steady-state mode on some sort of treatment), I go back to her for the routine monitoring -- there's no need for the extra expense or wait times involved with seeing a specialist.

OTOH, I had undiagnosed hypothyroidism many years ago and the "gatekeeper" plan I was on delayed my diagnosis by two years. More than one PCP decided my problem was depression and wouldn't consider testing anything other than my TSH, which was "fine". It wasn't until I switched employers and got on a PPO plan that I was finally able to see an endocrinologist, who told me I had Hashimoto's thyroiditis, and based on my symptoms and history, had had it for years.

When I first starting looking for help, I didn't know what was wrong with me. By the time I finally saw the endocrinologist, I'd been increasingly convinced for a year that I had a thyroid problem but couldn't convince any PCP of that. That experience makes me strongly opposed to "gatekeeper" plans, although I think it's a good idea for people to self-impose that model as a first option.

But in fact, he enjoys primary care and really explains what I need, including any need for him to refer me to a specialist. His referrals have turned out extremely well for me when necessary. So I trust him.

And the Canadian system seems to be quite popular among DUers.

Perhaps a Canadian DUer could confirm?