Tag Archives: specialist

Medical Group Madness

Last time, I had a HMO Nightmare. This time around, I suffered through Medical Group Madness. I was finally getting the hang of all the health insurance terms (medical group, primary care physician, specialist, and insurance provider). All my ducks were lined up right? Wrong!

I sauntered to the front desk of my wife’s new OB/GYN. I smuggly looked at my wife and whispered, “I got this”. I explained to the receptionist that my wife was changing OB’s in the middle of pregnancy because we changed insurance companies. She countered, “Where’s your authorization letter from your primary care physician?” I fired back, “I spoke to my insurance provider and they told me pregnancy is the one condition where you don’t need a PCP referral for a specialist.” She blankly answered, “Insurance companies don’t know what they’re talking about.” After some back and forth, we still needed a PCP from the same medical group to authorize our OB’s care.

Since my wife is so far along, I ate the cost. Hopefully we can reconcile at the end, but some things are more important than money. After the routine visit, we hustled over to the PCP office. Thankfully, she was in the same building. Sadly, my wife would need to make a separate trip to see her because she can’t just sign a form and turn it in. How many hoops do we need to jump through? Do we need to set Fire to the Rain? I’m really beginning to burn!

Final Thoughts

Looks like we dodged a bullet as my wife has a new OB, in network. For those of you switching to HMO, make sure your primary care physician and specialist are in the same medical group and are considered in network by your insurance provider. In my opinion, your insurance company is a general guide, but for the finer details of your benefits and coverage, I would lean more on the doctor’s office and the medical group. Everyone’s situation is different so make sure you do your due diligence. Tune in next time when we try and nail down a hospital for maternity services.

What’s your health insurance advice?

Stay Inspired!