I suggested a specialist in my network so that I can better coordinate your care and advocate for you. However, I would like to learn more about the relationship you have with your specialist so that we can come to an agreement on what will work best for you.
I'm sorry you feel this way. If you are concerned about a health care decision, it is important to discuss it with me. I'm committed to making sure you get the best care and that there is timely and effective communication among all the doctors you see. OPTIONAL COMMENT: If you would like to see a doctor outside of this team, you always have the option to choose a new primary care provider.
You do have second opinion benefits under your HMO plan—and this would be coordinated through my office [PCP's practice] using the qualified providers within my network. Let's work together to discuss your needs and expectations, and then determine which specialist you should see.
I'm sorry you feel that way. Let's talk about your frustrations and see if we can find a solution together.
As a member of a "health maintenance organization," you need to understand the basics of how to use your plan so that you know how your health care services are covered. This includes understanding that:
Please remember that you are responsible to confirm with Blue Cross Blue Shield of Massachusetts if the services provided to you will be covered and to ensure that necessary referrals or authorizations are obtained before your visit. Our practice works with Blue Cross Blue Shield of Massachusetts to obtain the referral/authorizations on your behalf, but the ultimate responsibility is yours. You are also responsible for paying for covered services that are subject to your deductible, if you have one, until you're deductible is satisfied.
As your PCP, I want to coordinate your care with the specialists my practice collaborates with. I know your history and health care needs and can help you decide whether a specialist visit is needed. I refer to specialists I know and trust and with whom I have a relationship. This way, I can coordinate with your specialist and, working together, we can provide you with the greatest degree of collaboration to help you get high-quality, timely, and effective care.
Our relationship is a partnership that is built on trust. I am committed to working with you so you get the care you need to keep you healthy. If you still disagree with my recommendations, you always have the right to change PCPs. But I hope you understand that my first priority is your health, so every decision is made to coordinate your care.
Generally, I refer within to specialists and hospitals that I work closely with because this allows for better coordination of care. Let's discuss your concern so we can work together to meet your child's needs.
There are major differences between a PPO and an HMO. First, a PPO does not require a referral—you can see whatever provider you want. An HMO, on the other hand, requires that a PCP coordinate all your health care needs. As your PCP, I work with you to coordinate any services or treatments you receive. In this role, I know and understand your health history and your health care needs—including whether you need to see a specialist. When you do need to see a specialist, I will refer you to a member of my own high-quality provider team. We will work collaboratively to see that you get the care you need at the right place and at the right time.