According to my insurance company, Aetna, the medical practices of HMO-accepting doctors are controlled 100% by Medical Groups. They told me that they receive complaints about the medical groups constantly, and that CA is (almost) the only state in the Union to use medical groups. I even spoke with supervisors at Aetna who talk about how bad medicine is for patients in CA because of the medical groups.
From what I can tell, medical groups only get in the way of providing care for patients.
For instance, a doctor gave me a referral to see a dermotologist to find out why the skin on my ankle was blistering and peeling. It took four weeks (from the doctor’s desire to give a referral, for me to receive the referral, and then for me to make and show up at the appointment). By that time, the skin damage was mostly healed, and the derm could not tell me why it was blistering and peeling. Was this from frostbite? A spider bite? An infection? Something else? No clue. If the referral system was faster, he would have been able to provide a diagnosis.
Another doctor told me he wants me to get a bone scan on my ankle. This is on Monday last week. I am to just sit patiently and wait for a referral to come in the mail. It’s now Thursday of the NEXT week, and I have no referral. Meanwhile, I’m in pain every day, and I am paying my insurance company for my medical insurance every week from my paycheck. And I’m not getting care.
My ankle has been a pain and a problem for 4 months, but due to the medical group lagging providing referrals, it’s often 2-3 weeks (and sometimes 4 weeks) between appointments. Again, meanwhile, I’m stilll in pain every day, and my condition seems like it’s getting worse every day.
These medical groups seem to radically increase the cost of my insurance (we have an office in Arizona, and their insurance costs a fraction of what ours costs) and only lowers the level of care patients receive (our employees in Arizona don’t get the run around we get in CA).
Is it just me? No, everyone I know in CA who has gone through HMO has the exact same difficulties. Doctors do not want to give a diagnosis or prognosis on the first visit, will schedule you for several visits so they can get more money from your insurance company (and your $20 copayments).
So - what “good” does the medical group actually do? Why are they here? Why can’t my doctor just refer me to the correct specialist without some other company getting in the way? Why did the medical system stop caring about providing care for patients, and just making money off of us?