Kind of a strange subject line, I suppose. Who doesn't have experience going to the doctor from time to time? (There's no need to brag if you avoid the doctor, thank you.)

So, I need to have a physical. I'm having some issues, I don't know what's going on- from a urinary tract infection, enlarged prostate, diverticulitis, or worse, much worse. The worstest. I'm insured through my wife and the insurance provides for an annual physical, free of charge.

Currently, I have no doctor except for a cardiologist. So, I started looking around and found two doctors in my area I feel would be good for me. The one I chose first is not currently accepting new patients. On to the second one. I call the office, speak to a nice young lady. She takes my information and says she'll send me the 'new patient' paperwork so that I can have it filled out when I arrive, yet she doesn't ask me why I feel the need to be seen. She tells me it doesn't matter at this point, because the doctor will want to see me for an initial patient workup, and then we can get down to business.

Money is tight for me right now, and even though I know without any doubt that the physician is going to order additional testing beyond a routine physical, such as colonoscopy, perhaps a GI, MRI, CT scan, etc., it was comforting to know that my initial visit would be covered 100% by insurance. My insurance has a very high deductabe, so perhaps it doesn't matter about having to pay for an initial visit, but why do I get the feeling that this doctor is lining his pockets?

Hence, my question to our physicians and experienced patients (old guys, like me)- is this normal these days? Why can't I say "I need a physical" and then go and get a damn physical, without having to lay out probably three hundred bucks, just to get to the point I can get my insurance-covered physical?

I am like many of you- I will not go to the doctor unless I'm having obvious, alarming symptoms. I feel like I'm over a barrel here. I'm already looking for excuses to not go at all. Any advice is welcome. Thanks

It’s been my experience (nowadays) that often the primary docs around here like to do the “introductory” visit before ordering tests, etc. for insured patients.

For “self pay” patients, it’s my experience that you say what you want done and they accommodate your wishes.

Of course, that’s in these parts.

Depending on your plan and your relationship with your cardiologist, he or she may be able to refer you to another specialist for symptoms you present to them. I’ve had some shoulder and orthopedic issues do to service and work related activities. My orthopedist on hearing my complaints of headaches, balance issues, and dysphasia referred me through my insurance to a neurologist.

Your symptoms could touch on issues related to cardiac symptoms and the cardiologist could send you to a GI specialist or urologist.

I am fortunate to have decent insurance and a doctor I have had for 25 years that I really like and trust. Over the 25 years I have gone from ZERO deductible to $7500 max out of pocket which basically means I pay a portion of everything until I hit that max. 5 out of the last 10 years I have maxed out my deductibles with various surgeries. I am coming up on 60 and I am pretty sure i will continue to use my insurance.

Having said all that, I have had conversations about the expense of tests to me and I explain that if he feels it is necessary then I am ok with it. I do annual blood work once a year for my Doc and Cardiologist. If something shows up in the blood work, sometimes I get more done with a change in meds. Every other year I have a stress test. And then every other year I seem to have a surgery.

Having said all that, the important thing for me was to find a Doctor I could trust. I got referred to my current general sports doc via a hand injury and we hit it off immediately. I could not imaging going to a guy that made me feel like he was a car dealer upselling everything.

Good luck. I will say some of those tests saved my life.

Must be normal. I went through the same thing when I switched doctors.

There was a phone call to verify previous issues, and any concerns I might have.

Then there was an introductory visit to just talk about things

Then finally I got a physical.

The whole thing took about a month and a half.

I like spunk's idea! I'd do that. The GP will send you to a specialist anyway.

As you alluded to, preventive care, including an annual physical, is 100% covered by law under ACA so it applies to all insurance plans. Routine colonoscopy should be covered 100% as well, but I'm not entirely sure since I haven't had one. For women, mammograms and PAP smears are covered too. Even STD screening is covered if you just "want to make sure".

Start with everything that is fully covered under preventive care. If something shows up that is not right, then diagnostic services to investigate further will be deductible and coinsurance CT, MRI, etc.

The initial visit should be a standard office visit, which is usually capped by insurance. For me if I get billed $125 for a GP visit, insurance caps it at like $75 which I pay from my HSA. My deductible is 3000 a year so I never hit it unless something major happens.

I changed doctors in 2016 and I walked in with the records from a free annual physical from work. He looked at all the results, advised me on any actions, provided updated Rx's for anything I was already taking, and that was pretty much it.

quote:

Originally posted by Lefty Sig:
Routine colonoscopy should be covered 100% as well, but I'm not entirely sure since I haven't had one.

Well, I had one in December, 2013, and it wasn't 100% covered. If that's changed since then, that's good news for me.

Not a family practice doctor. I am an anesthesiologist. Have a big internal medicine and surgery back ground. If you want to talk off line please email me. I will make time for you tomorrow. Let me know.

quote:

Originally posted by parabellum:

quote:

Originally posted by Lefty Sig:
Routine colonoscopy should be covered 100% as well, but I'm not entirely sure since I haven't had one.

Well, I had one in December, 2013, and it wasn't 100% covered. If that's changed since then, that's good news for me.

I’ll throw this out to you. If your symptoms seem to be GI related and you have patient history with a GI specialist from the 2013 colonoscopy (assume that was in Atlanta), then why not contact that doctor and see if he/she will see you?

I just had my annual physical in December. The actual doctor time was actually with a PA and she ordered bloodwork, EKG , echocardiogram, and a chest CT, all preventative. I finally got the approvals for the CT, echo, and EKG and had it all done last week. I'm the guy that never used to go to the doctor but at 61 it's not a bad idea I guess. All the tests were a pain in the ass for me but I figure if they had done this kind of stuff when my dad was still here he might have had more time here instead of having a massive heart attack. I expect it's all normal these days and you're probably right, partly a money grab, but if it keeps us here and kicking longer it's worth it.

Para, what you describe is the norm nowadays. The Dr will review your paperwork before your visit (should at least).

Then he or she will do an exam. After which suggestions will be made. My wife just started seeing the rheumatologist that I’ve been seeing for a few years. She, the doctor, is very thorough will spend as much time as needed to explain things to you and will answer questions.

Hopefully you’ll get a doctor like her. My pacemaker/defibrillator phones home every month. I think that’s a bit too often, but it comes as a $250+ each time to look at it and send me a letter stating what I already know.

I hope all goes well and if you have any personal question feel free to email me, or we can talk over the phone if you’d prefer.

Best of luck,

quote:

Originally posted by 1flynDO:
Not a family practice doctor. I am an anesthesiologist. Have a big internal medicine and surgery back ground. If you want to talk off line please email me. I will make time for you tomorrow. Let me know.

Many thanks.

quote:

Originally posted by TMats:
If your symptoms seem to be GI related and you have patient history with a GI specialist from the 2013 colonoscopy (assume that was in Atlanta), then why not contact that doctor and see if he/she will see you?

Because he was a real son of a bitch, and his office staff was infected with his jerk attitude. It's not a place I would ever again wish to see.

quote:

Originally posted by mark60:
All the tests were a pain in the ass for me but I figure if they had done this kind of stuff when my dad was still here he might have had more time here instead of having a massive heart attack. I expect it's all normal these days and you're probably right, partly a money grab, but if it keeps us here and kicking longer it's worth it.

I had hoped to get out of this existence without ever having had another man fondle my balls.

quote:

Originally posted by beltfed21:
I hope all goes well and if you have any personal question feel free to email me, or we can talk over the phone if you’d prefer.

Thank you.

quote:

Originally posted by parabellum:

quote:

Originally posted by Lefty Sig:
Routine colonoscopy should be covered 100% as well, but I'm not entirely sure since I haven't had one.

Well, I had one in December, 2013, and it wasn't 100% covered. If that's changed since then, that's good news for me.

It appears to be complicated. It's supposed to be covered 100%, but if a polyp is found and removed many insurance companies want you to cost share the "treatment" part of the procedure. The government countered some of this because they consider polyps removal to be part of the colonoscopy. But then the insurance companies decided that if you ever have a polyp removed, future colonoscopies are not preventive anymore, but monitoring for treatment of a known condition. Guess they will try to get whatever they can get, and if you don't agree with it you can appeal.

I had this issue with cholesterol. Once you have high cholesterol and are taking a statin, the annual blood check is no longer "preventive".

Your experience is not uncommon these days and I went through the same experience as you. I too have a high deductible plan and had my wife’s and my own colonoscopy completely covered by insurance this year. I have type 2 diabetes which came with a rapid onset of peripheral neuropathy. I fired my primary care doc of 15 years because I knew more about the diabetes meds required to help keep me moving on. I starting working with my new doc last year after getting a referral from a neighbor in the medical field. My new doc is awesome and seems to really care about his patients and not how much he can make off them. I would think before you start going for special tests, a good doc would order comprehensive labs. A lot of information can be learned from bloodwork especially as it relates to the prostate. A good primary doc is like a good mechanic and they should be able to do some diagnostics to come up with a path for treatment. My doc was also very good with helping guide me through the bullshit my insurance put me through regarding meds and the ridiculous cost.

I’m an urologist. If you need to talk please email me! After all the years of enjoying this site it’s the least I can do. If it needs t be an ‘official’ visit I can do telehealth. I’ll do whatever I can!

Family Practice here.

Happy to field anything from you sir.

Email in profile.

Thanks very much, Guy1 and jjkroll32. I do appreciate, very much, the kindness all of you are showing.

I spent nearly two decades in the medical field and worked closely with MDs, and came away from all of it with a certain cynicism towards the practice of medicine in our modern times, but there are good people out there still.

I went to MSU in Michigan, proud to be a DO! It was ranked in the top 5 for primary care. The biggest thing I learned and witnessed was to listen to the patient. They will tell you the diagnosis. Then do your physical exam. Then order what you need to confirm.

Yes a lot of docs order more than they need to these days.

Para,

Have you asked your Cardiologist if he will he act as your primary care Physician?

My Cardiologist is one of the top doctors in this area and acts as my PCP. I’ve been his patient since January ‘98 and have total confidence in him.

He schedules all of my routine tests, refers me as necessary to other specialists or consults with colleagues who are specialists as needed.

Might be worth asking especially if you have full confidence in him.