Monday, November 15, 2010

Out of Network & Out of Pocket

 Photo courtesy obraprima

When I was younger, my family doctor was the same doctor who delivered me…and my mom…and her mom.  Needless to say, my doctor passed away before I was a teenager.  Since then, I haven’t had a real family doctor.  I never needed to see a doctor much so I suppose it didn’t seem like a big deal then.  When it came time for me to need a doctor for regular physicals and things, I didn’t know where to begin.  I still don’t.

As I came of age and had a job where I finally had health insurance, I randomly selected a doctor that I knew of because he had done my dad’s colonoscopies.  This doctor was a DO, which meant nothing to me then, and practiced gastroenterology and internal medicine.  Fine. Whatever. I didn’t care at the time.  I really didn’t know what to look for or how to find a doctor. I just needed someone to give me a physical, keep my prescription for birth control current and see me for the occasional illness.

Of course, I was rarely ill and, when I did go to the doctor, I never actually saw the doctor. I saw the Physician’s Assistant. That was fine because the PA was a woman and I am much more comfortable seeing a woman for my womanly issues.  It was fine, at least, until the PA made a few remarks that made me very uncomfortable.  I was having a chronic problem with yeast infections. I was having one at least once every month.  When I inquired about what could be causing them, she said something about how the only two things could cause chronic yeast infections: diabetes and HIV.  Talk about scaring the hell out of someone…and for no reason. It wasn’t until I went off of the pill that the real culprit came to light.  It was, in fact, the pill cause my problem!

In recent years, I’ve made an attempt to find a doctor closer to work.  It makes sense to be able to leave work and drive 15 minutes to the doctor at any time of the day rather than trying to drive 45 minutes one way and fitting in a doctor’s appointment either in the morning (beginning of the day) or afternoon (end of the day) which never seems possible anyway.  But how does one pick a doctor in a town they are only vaguely familiar with?  By asking friends and coworkers, of course.

This led me to my last doctor who was ok, at first.  Then she started giving me life advice and telling me how to sort out my life and which decisions I should be making based on her own beliefs and only bits and pieces of my life story.  Thank you, but I’ve already seen a shrink for this.  There are also issues that I have been having that she had no idea how to fix or what to do.  She said to me, “I know that your issues are hormonal, but I don’t know what to do for you.”  It was probably a blessing in disguise when she sent all of her patients a letter saying she was leaving her practice to go explore opportunities at the local hospital.

At this point, I had had enough. I just wanted someone who wouldn’t look at me like I have two heads or three eyeballs when I say I’m having hot flashes!!!  Based on the advice of my friend/landlord, I went to see a doctor who is a D.O. and is also dedicated to holistic healing.  This doctor doesn’t accept insurance and, thus, is considered out of network.  Because I was/am desperate to find someone who will help me, who won’t make me feel like I’m crazy, and who can offer some kind of solution to my problems, I decided to give it a whirl.  

My initial visit was one full hour with the doctor and $425.  It wasn’t what I had experienced in the past as a typical office visit. No one weighed me, took my blood pressure, took my temperature or looked in my ears. I arrived a few minutes early and the doctor herself called me and took me back to the room.  There was no waiting and there was no one else in the office waiting to be seen.  She sat in a chair and I sat across from her. She said to tell her what was going on. I explained my main issues being that I feel like I’m having hot flashes even though everyone says I’m too young.  “In fact”, I told her, “I’m having one right now.”  She asked me to show her where I was feeling hot and I did. She said I was indeed having a hot flash!!! 

I explained more about the issues I was having - anxiety, panic attacks, I was edgy and not able to sleep, not being able to focus, fatigue, a chronic no-apparent-reason rash, weight gain, loss of libido, night sweats, some serious acne, a serious sensitivity to smells and perfumes, and digestive problems.  After listening patiently to my problems and my theories about what I thought caused some of them, she told me there is definite potential for a hormonal imbalance. She explained to me and drew a diagram about how our hormones work and are created, what affects stress can have on the production of different hormones and how things can be thrown off kilter.  When it was all said and done, she had given me a full prescription page full of labs that needed to be done, a 24-hour urine home analysis kit to check for toxins in my system and a suggestion for a natural antihistamine for my scent sensitivity.

I left that office beaming.  Even though we didn’t know exactly how off kilter my hormones were and I had to wait at least a month to find out, I had to drive 45 minutes one way, AND it cost me $425 of my own money, I was ECSTATIC!  Someone believed me! Someone actually thinks that there is something we can do to fix me!  (I actually ended up waiting six weeks to see the doctor again.  My blood tests had to be done in a three day window within my cycle.  Apparently, my cycle was off (another issue) and it takes two weeks to get the results from the tests.)

My second appointment was all of fifteen minutes.  Again, I was the only one in the waiting area and the doctor herself greeted me and took me to the room.  She showed me my test results and explained everything to me.  All of my hormones are out of whack and my testosterone levels were “the lowest of any woman I have ever seen,” she said.  I also had toxic levels of lead in my system. Kind of creepy, no?  I walked away with a page of instructions and my prescriptions were called into the super pharmacy that compounds their own medications and then mails them to me!  In the morning, I take 6 pills to “get the lead out”, 1 DHEA supplement, 6 drops of vitamin D that amounts to about 2500 times the daily value, and I slather on a testosterone gel.  In the evening, I rub in a progesterone cream. 

It’s too early to notice a change, but I am so excited to be doing something. I am excited to know that I’m not crazy. There is something out there to help me.  I want to share my doctor with all of my friends who are having issues that no one else can seem to solve. 

The medical profession is frustrating to me in so many ways.  So many of my friends have issues that there is no real solution for. Everything is a try this and see if it works approach.  If that doesn’t work, we’ll try something new.  My friend’s issues range from migraines and insomnia to epilepsy and chronic depression.  It’s so frustrating. And finding a doctor, a good doctor, is so very hard. 

Anyway, if all goes well with this hormone therapy program, I would love to recommend this doctor to anyone.  The initial cost seems like a lot.  Of the $425 initial visit, which I did turn in to my insurance (the doctor’s office gives you a medical billing form to help with that), $236 of it was covered by my insurance.  That, however, did not even cover my $250 out of network deductible.  (It’s sad that extremely good money is paid for insurance and you can’t see any doctor you want and have it covered.)  I am still waiting to see how much of the second visit will be covered.  But the doctor only makes you come see her when it’s absolutely necessary. She is having me check in around the two week mark via email.  If I have questions, I can call or email (which I have done).  If something isn’t working, email.  She makes it clear that she’s not there just to take your money.  She wants to help you and is willing to help keep the costs down and work with you in a manner that works for you.


  1. That's so great! It's too bad we can't see the doctors that are best for us without paying out the ass.

  2. Agreed! It's also a shame that it's so hard to find a good doctor.