The board in general. It’s highly frowned upon since (presumably) no one here is your doctor or has access to your medical records.
Got it. Danke schoen, baby.
I’m not from California, but the impression I’ve gotten after Googling your medical group is that it’s one of those places run kind of like law firms - some of the doctors are partners, others are employees, and none of them has a truly independent practice. In which case, Aetna probably won’t be able to do much except drop the group as a participating provider. I suspect that what Aetna told you is that all they do is either pay or deny the claims- because that really is all they do. They don’t direct your medical care , and they don’t decide whether or not you should be referred to a specialist. Your problem seems to be that your primary doctor belongs to a poorly-run group practice. Not every group practice is like than , and some individual practices are managed poorly.
It’s been awhile since I’ve had an HMO, so things might be different now, but I’m not aware of anything like you are describing with my medical group. All my referrals, even when I had an HMO, were filled out by the doctor and handed to me on the spot. I would then carry that piece of paper to the receptionist at the specialists and they would set up an appointment for me. Now some specialists had particularly long lines (several weeks) but that was only an issue if you wanted to go to that particular one. There were usual several specialists in each field I could usually be seen within a couple of weeks. If there was a medical reason for why a couple of weeks was not acceptable, they would usually try to squeeze me in same/next day. This has nothing to do with medical groups, but rather supply and demand.
What you are describing is my memory of HMOs from 10+ years ago. I was very healthy for over 10 years, so really haven’t had to go to the doctor very often. If things changed slowly over those 10 years, then it was a real shock to return to the medical system to find it in such disarray.
10 years ago when I broke my ankle, referrals were as you describe - the doctor writes it up, and I can call the specialist he referred me to, or another specialist, and go. Now, the doctor doesn’t know who I’m being referred to until after my name has been through the medical group system. At least, according to the doctors, and according to Aetna. Maybe it’s just this medical group … if so, then when this round of treatment is over, I’m out of here, even though I really like my Primary Care Physician.
If a doc gives me a referral to a specialist now, and I go to another doc, then insurance won’t cover it. In a PPO, I could go wherever, but I can’t switch to a PPO until June next year.
I recently got assigned to physical therapy and have been going for 4 weeks. I asked the head therapist, while he was working on my ankle, about a response I got from the doctors. “When I told them it hurts in three places, they would refer me to another doctor rather than investigate further.”
“Are you on a HMO or PPO?”
“HMO”
“They are referring you on because they don’t want to deal with it.”
We continued talking about it, and in his opinion, it took me nearly 6 months before I got referred to treatment (which no one is convinced is the correct treatment for my issue) purely because I’m on HMO instead of PPO.
So why do I pay money to be treated like a second-class citizen?
You pay money to not be treated like a third-class citizen? 