It depends on the HMO or insurance company. Some of them are (my opinion) EVIL and won’t let you see an endo no matter how much you need one – it’s all about the $$$. Others will refer appropriately. It really varies.
With all the complaining and hysterics about “death panels” with the efforts at health care reform, I just shake my head because we already have “death panels” in the form of for-profit insurance companies and HMO’s that refuse to provide appropriate referrals and appropriate care to people like us with serious, chronic conditions.
My PCP is an IDIOT. The quote that ended my trust in her for all time was saying “you’re going GREAT” when we just got back an HbA1C that was 10.7, my second in the mid-10s in six months. I wanted to scream at her.
I’ve had to fight my HMO all the way – to get enough test strips prescribed, to get Lantus prescribed several years ago, to get Novolog prescribed this year. They wouldn’t let me try Byettta two years ago. Now they won’t let me try Levemir or a CGM. My sugars fluctuate between 34 (lowest low) and the high 400’s (highest high was over 500 but that was a one-time thing) – I am NOT “doing great”. I have hideous dawn phenom, hideous insulin resistance and neither my PCP nor the “really good with diabetes” internist she recommended me to have one, single CLUE about how to help me.
They’re utterly clueless idiots, and I’m being generous there.
I got something like FOUR MINUTES of instruction when she finally prescribed Novolog to me – my first-ever prescription of fast-acting insulin and NO ONE at my HMO is qualified to train me how to use it – they don’t even have a CDE to refer me to, no classes, no hand-outs. They gave me this stupid sliding scale that stops at 250 and she gave me no idea of what to do if it’s over 250, a regular occurrence at my house. She didn’t say one word to me about hypos, how to treat them, how to be prepared for them, signs to watch for, nothing. I said I wanted to know how much to inject to cover the carbs in my meal and she said, “Really? Doesn’t that sound like a lot of work?” I wanted to slap her smug face. YES it sounds like a lot of work – controlling diabetes is a lot of work – but going blind and losing your feet is a lot of work, too. Freaking idiot.
The pharmacist had to explain to me how to use the Novolog pen and she did so by READING THE INSTRUCTIONS in the box. She didn’t know how to use the pen. No one there did – and they’ve been out for years.
I feel like my HMO’s bean counters WANT me to die so they won’t have to provide me with care any more – like they really are a defacto “death panel”. It’s horrifying, really, how incompetent they are.
Fortunately, I have books and the Internet or I’d be dead already. Not one of the doctors at my HMO has the knowledge of a 10-year-old type 1, three months after diagnosis. Not ONE of them has that much competence.