Here is the link to earlier and later posts in this series
When it comes to navigating the healthcare system, it is important to understand that one basic component of the system is your primary care physician (PCP). That is not the only doctor’s office you will deal with, but it important for you to understand the difference between your dealings with your PCP and all the specialty doctors. In fact, you may even see some of them more often than your PCP at times.
It is also important to understand the important connection there is between your PCP and the pharmacy and your PCP and your ability to qualify for payment for your specialty doctors…depending on your insurance plan. That is why I talked about insurance from the beginning. They dictate so much about what you can qualify for in terms of treatment and even in terms of whether a doctor is willing or able to take you on as a new patient.
If you understand these links, it will help you understand how to present yourself or your loved one to a doctor’s office with the most confidence. So let’s take a closer look at what happens when you arrive at a doctor’s office (PCP).
Dealing with your Primary Care Doctor’s office
Generally, dealing with your Primary Care Doctor’s office will start on the phone. You are calling for an appointment. If you are a Medicare patient who is trying to get in, it may take awhile. Some people think they can just pay extra and that will fix the problem, but it is illegal and will get your doctor in all kinds of trouble. Definitely don’t offer to pay him extra.
With some insurances, your doctor has to be “in network” so that might be a consideration. Be aware of this situation and know if the doctor you want to make an appointment with is “in network” for you. If he/she is out of network, you will pay extra or may even have to pay the entire bill.
It is important to remember that when you call to set up an appointment, the person who answers your call is almost never a nurse. She probably has some familiarity with medical terminology. She does know the routines of this doctor’s office and how they routinely schedule patients. She also has a working knowledge of the insurance rules as well as individual guidelines of the particular doctor you are trying to get in with. You are wise to schedule through her and not short-circuit the route through which you do it. Otherwise, it might come back to bite you.
Routine Medication refills–Local Pharmacies or Mail Order Pharmacies
Once you have seen your PCP, he/she will be the one to refill all your drugs. However, they prefer that you deal with that when you are there for an office visit for the most part. If you can keep up with refills during office visits, this will rarely need to be done by phone. If you have your meds refilled on your routine visits, that will solve most issues with drug refills.
Occasionally, you will need odd meds refilled and you can have them done by phone where you call in to their refill line and leave a message regarding the refill, your phone number, the name and birthdate of the person to have medication refilled, drug and dose, etc.. But refill often takes 24-36 hours to work its way through, depending on the office. This is for routine refills.
If you are talking refills for controlled medications such as stronger pain medications, sleeping pills, etc., that is a different story. Those can’t be called in. They must be hand written by the doctor. Each office has a different requirement. If you have that kind of medication, you need to be sure you understand your doctor’s protocols. Plan ahead for refills when you have your doctor visit so you don’t come up short on refills when the time comes.
They won’t be intimidated by the fact that you weren’t paying attention and ran out of your prescription late on Friday afternoon. That is a common trick of drug seekers who don’t want to see the doctor for routine appointments. If their patients gets caught selling prescriptions, they are the ones who can lose their license and livelihood. I don’t want to be mean about it, but you need to understand something of their perspective too. It isn’t a light matter.
Miscellaneous Responsibilities of your PCP
Basically, when dealing with your PCP, you need to know how they deal with routine appointments/lab work, medications, and having sick patient appointments. Your PCP is in charge of your overall healthcare. They manage your routine lab work to be sure your medications are not causing you problems. When you have immunizations, let them know so it gets on your chart. They also check you for routine screenings as well. If you are hospitalized or seen in the ER, your information is sent to the PCP too…usually. But be sure they have been informed of any medication changes or new diagnoses.
Depending on your insurance plan, if you need to consult another specialist, you often must be referred through your PCP. Often, even if not required by the insurance company, more and more of them want your appointment set up through the PCP’s office so they get the history of your condition correct. They also want to be sure your PCP thinks you really need to see a specialist for the problem. Depending on the doctor, you are still likely to have to wait a month or more for an appointment.
When calling in to the PCP office…
The main piece of information you need to have when calling into most PCP offices I know of, is your birth date. When I call in, I give my name, my husband’s name (that is who I am usually calling about.) and his birthdate. The next thing she often wants is my phone number. Then I ask what I need to ask, or set up an appointment or whatever. I try to be brief because I know they are busy, yet I still need to give them the appropriate information.
Your PCP is the primary doctor who cares for you but realistically, you need to be aware and updated on all your medical information for yourself and your loved one.
The doctor can’t remember everything about you. You need to be alert more than ever and know what is happening. That is what makes caregiving a big responsibility.
Hopefully, you have gotten the idea that your PCP is the doctor that manages your healthcare in general. But honestly, he has a lot of patients. You need to be on top of your healthcare and that of those for whom you are giving care. Keep a file with pertinent information like major illnesses, surgeries, procedures, and of course medications with doses and how often they are taken along with drug allergies and drugs that aren’t tolerated well. The medication and allergy list should be on your phone so it is handy whenever you are at a doctor’s office, ER, our hospital. That information is always needed.
I could write much more about dealing with Doctor’s offices, but this tells you the basics. Please add comments below to tell me the things I have missed.
fear not, for I am with you;
be not dismayed, for I am your God;
I will strengthen you, I will help you,
I will uphold you with my righteous right hand.
Isaiah 41:10 ESV