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HMO Restricted Referrals = Bad P Treatment
from Tiffany

Hi Ed: I hadn't needed to see a derm in years, but my P really flared early last year. I asked my GP for a referral to a derm, which she refused, saying she could handle it herself.

When the steroid creams she prescribed didn't help much, she prescribed a 5-day oral steroid pack and my P cleared immediately, then flared HORRIBLY. So I called up and asked for another pack. Again, the clearing and rebound. By then, I was so frustrated (I sobbed when it spread to my hands, a place it had never been), that I was all over the Internet trying to find answers. I went back to her office armed with my printouts warning of the use of oral steroids and got my referral. Only no one would take me because my HMO had just been bought out. I couldn't afford to see a derm on my own and I was too afraid to use anything my GP prescribed (she handed me a bag full of Tazorac samples one day with no literature or instructions). So I did nothing for several months.

I'm happy to report that on Jan. 1, I was able to change insurance companies and am seeing a wonderful psoriasis specialist. I'm seeing slow but steady improvement of my now "severe" P with narrowband UVB (she says she's not going to waste my time with topicals — first time I ever heard that).

The scary part of this story is that while I was waiting for a treatment, I started comparing notes with a guy who was also waiting. He had the EXACT SAME tale to tell! I asked the doctor about it and she said she hears this steroid story all the time. GPs are restricted by many HMOs as to the number of referrals they give. And sadly, many are trying to treat a condition with little or no understanding of it. One would think oral steroids make sense, but they can really cause a lot of damage. All it took was one look at the NPF site to learn that, but most GPs probably don't bother. And unfortunately, GPs are all some of us can see.

Thanks for letting me vent. -Tiffany

*****

Ed’s Response: Thanks for this awfully informing story, an appropriate addendum to my own insurance woes shared in last month’s briefing. I wish, though, that you would have named names (not the GP, necessarily, but at least the HMO). If you are uncomfortable doing that at FlakeHQ, please consider forwarding your story with names to the National Psoriasis Foundation. While I’m sympathetic to the HMO-specific conditions under which affiliated doctors must work, that simply means docs and their HMOs must share responsibility for providing bad health care — and that’s exactly what you got, bad health care.

All that I’ve heard about narrowband UVB has been good ... and you certainly deserve your turn at the latest and greatest treatments. Is your current derm on the NPF’s referral list? I hope so!

Stay in touch, Tiffany. -Ed

P.S. For more on narrowband UVB, use the search function on the FlakeHQ home page.

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