Doctor Selection - Need Help

[pozbottom]

Hi,

I've just found out.  HIV+.  New life ahead....

So, here's my dilema.  I can get health insurance.  But what plan, PPO, HMO, Kaiser?  The crucial question is, what doctors are out there that specialize in HIV treatment, that take any of these plans!  I've spent the last couple days, searching, and have found little information.   POZ.COM could really help out the community by having a doctor/group referal system that integrates doctor databases with a blog of peoples experiences so there's information about who's best serving the community.

Help!

I live in San Jose California.  Found the Positively Pace Clinic here, as part of the Santa Clara County medical system.  I really wish to use their services, but they don't take HMO's.  Where do I find doctors that do, that specialize in HIV treatment?  Outside of HMO's there are PPO's, and Kaiser, which could work, but that's totally unknown to me.  I coiuld do either of those (haven't commited to an HMO yet), if I only knew who is the best out there.

So, I'm trying to move forward, but can't find enough information to make a very life important decision about my future health care.

Please reply with ideas and resources!

Thanks so much.

...Doug

[Matty the Damned]

Hey Doug,

Welcome to the Forums babe!

I can't help with the specifics of your questions on account of I'm an Aussie, but I'd suggest that you post your questions in our Living With HIV Forum. It's a higher traffic forum and you're more likely to get useful replies.

Perhaps one of our kindly Goderators will move your thread for you.

Once again, welcome!

Fondly,

MtD

[risred1]

HIV docs are specialists and HIV falls under Infectious Diseases Specialty.

So First I need a primary physician if you have an HMO or PPO type coverage. Once you select a Primary, you get a referral to a specialist. Often the specialist is available via a list of infectious Disease specialists on the HMO/PPO doctor lists.

I choose a university hospital, Penn Medical, and more or less picked one out of a Hat, based upon credentials. I am very happy with my guy! The rational for using University Hospitals is they often combine clinical treatment with research, so in general as a community, the specialists are up on the latest information and are very active working on HIV patients.

Boutique care from Kaiser, are free to follow any rules they want. Often they are not supported by HMO, because they don't attempt to contain costs as HMO's would dictate. The key here is to leverage a PPO that allows you to choose out of network Doctors, but remember that you will pay a premium in Co-Pay, and procedures and tests may be difficult to get coverage. Kaiser focuses on Intestinal Parasites and likes to test annually, while it is always possible to ask for a test from a HMO, unless your doc really feels its necessary, it becomes harder to get that test ordered and done, although once you have an HIV diagnosis, lots of blood tests are the norm. Essentially, if a doctor feels a test is necessary for an HIV infected patient, you can get it done.

University systems also have their own labs, so that sophisticated tests, especially the very complex Resistance tests are performed on their own facilities. Does that mean they are great? I can't account for that, but one can hope and has to hope they get it right!

So staying in network is easier to get things done, while boutique care comes at a premium(s), but you may be happier in the end with the Kaiser approach, which tries to keep you off meds as long as possible and tries to compensate for the side effects of the meds you may eventually need to take.

Lastly, if you want references for these specialists doctors, you may want to leverage local Strength in Numbers Chapters where you can ask around for a recommended doctor. And you can ask question about the specialists and their methods. Often people are used to their docs and find it hard to part with them even when they may not be doing what they should. So think it through, what kind of specialist are you looking for? A medicine expert? Someone open to alternative treatments? My doc is a Strict Clinician, and does nothing with nutrients, but he doesn't discourage me and lets me decide while encouraging me to wait on the meds until we reach that point. So in that regard he leave my supplementation routine up to me, and actually has more interest in these things since his patients are presenting him with information about supplements and herbs. He remain cautious, he questioned my belief in using full supplemented doses of NAC and Alpha Lipoic ACID and Carnitine but sees I've been somewhat stable over the last two years, which he stated has surprised him, and he doesn't surprise easily any more. (not that this is an endorsement of my regimen!).

I hope this helps! 

[milker]

Hi there, Welcome to the forums pozbottom!

I'm with Kaiser in San Diego. Kaiser is pretty big in San Jose, they recently built a "state of the art" facility on Lawrence in Cupertino. The good thing about Kaiser is that everything can be done at the same place, doctors & labs are usually co-located, so when you need labs done  or a shot it's on site and they come back fast. The plan I have is pretty good, the copay is $20 for a doctor visit, $10 for meds. The bad thing is that it's Kaiser and nothing else, if you need a prescription you have to get it at their pharmacy, unless you're out of a coverage area, and then again it's not every pharmacy out of state that will take the prescription so beware about that if you travel a lot. They choose the doctor for you or you can browse the list and chose, I've been pretty lucky so far with who they chose as Primary and as Infectious Disease doctors. They have an online system which they will upgrade this week with new functions, you can see your results online (although not HIV results  ), make appointments, etc..

If you need urgent care (i.e. same day), your Primary may not be available, so they will make an appointment with someone else. I've seen good and bad doctors in that case. The worst being the one seeing me for the Syphilis rash and said it was an allergy to lint 

Feel free to PM me if you need more info.

Milker.

[bradmeistr]

Doug,
 I have been positive for the last 5 years and have had experience with both Blue Cross PPO and Kaiser HMO in the City.  I started off with Blue Cross as I wanted to have as much choice given I would more than likely begin to access care more often than if I was negative.  I live in San Francisco so I have a wide choice of doctors.  My doctor at Blue Cross was great - the nurse practioner was awesome!!!, but then I had to switch to Kaiser as I switched jobs and the PPO offered by the new employer cost way too much.  Overall, I have been very happy with Kaiser.  I was very nervous about switching to Kaiser but after being with them the last 2.5 years, I can truly say they have been great, I am very pleased and do not want to switch from Kaiser. 

In SF they have HIV specialists so check to see if they have specialists in San Jose that you can pick as your primary care doc.  I also have an HIV care coordinator I work with, albeit very rarely, he is there to help you get the services you need at Kaiser - i call him for what ever I need - he is awesome and very professional.  It is kind of like having your own concierge.

I work in the manged care industry, not for Kaiser though, and with any insurance you need to make sure you demand what you feel you deserve. 

A couple of other notes about Kaiser, they mail you your lab results if you want that, keeps me from having to see the Doc every three months, you can email your doc online, you can order meds online or phone(even get some lab results online) , and it is very much a one stop shopping place.  At times, I wish I had switched to Kaiser a while ago.

One added note, I actually think you might get better service at Kaiser with HIV issues than the standard Kaiser member as I think they know the more they keep you healthy, the cheaper it is for them.

Hope this helps.

Brad

[FiercenBed]

this is one thing i know alota bout....unfortunately

i had Blue Cross & Blue Shield of NC when first diagnosed. This was full insurance but had a whole buncha restrictions. you can go & c anybody u wanted to. but the question was whether or not they were gonna pay. and i dont mean the doctor but the procedure the doc wanted to have done. for example im in viro failure. the doc wanted a resistance test. their policy sez they pay for a resistance test. the government policy sez to get a resistance test. but when they were billed for it they refused payment stating it was 'investigational' i had 2 go through 2 'appeals' and fly to Raleigh NC for the hearing. itza $800 test. after a whole buncha letters, reports, and a 'intermediate doc' i won the appeal. but it was a bitch. at the end of the day the point is read EVERY small detail in the policy. from what i understand kiser is restrictive and if ur doc leaves kiser, which is common, u lose ur doc and have to start w/ a new one. just what i hear.

the employer changed to united health care ppo so far theyv bn pretty good. i always call and verify the cpt code for any test or procedure. so far thev covered everything unlike BCBS. they actually had a nurse call me a couple of times and ask 'r u okay' 'is there anything we can do?' silly but cool i guess. point here is get a ppo so if ur not happy or the bottom falls out u can get a second opinion.

now for the doc.....docs r like apples in the grocery store....therez a barrel of 'em. trick is to find the best apple in the barrel. iv got docs 7 of 'em for a variety of issues....some i like & others i cant stand. but the i.d. doc is the key. hez or she is the one coordinates the show. like stated above am i gonna get a hold of this person without alota red tape if there is a problem? how is this person gonna react if the going gets tough. non medical jargon bedside manner. i really hate to say it but word of mouth really is the best recommendation. do ur homework and if u dont like the doc go back to the apple barrel.

as for clinics, i know im gonna get in2 trouble for this, but STAY AWAY. not only do u have to pay to see a doc....but u also have to pay for 'hospital services'. so itza double bill.  check out my post on johns hopkins is a rip off. i know its just one clinic but it was enough for me. jesus $735 for one appointment and once again bcbs dosnt wanna pay. the place is dirty & disorganized and iv got the proof. im still ina battle w/ them. true they do research and iv dabbled in it, but u get ur hopes up just to be dashed.

whew...long story...sorry. points get a major brand ppo....check the details.... dont forget medication is not always covered by the same insurance<like mine>. listen for some referrals from folks try the doc out if not move on. ull find 1 thatz just right.....good luck!