EIL5: How to find a new doctor, labs, etc. in USA, when moving

[macvalve]

Hi, I have a question for my fellow Americans. This is a pretty silly sounding question but I've only ever had one health care provider, an HMO (Kaiser). I will be moving across the country soon to NYC where Kaiser doesn't exist and I don't really know how I should go about transferring my care. I will have a new insurance and I know I can find a new set of doctors through the new insurers portal or just call around asking for doctors that are in network. But I've also heard there are wait times that are months long for new patients are many place.

I got a mechanical valve, take warfarin and get my INR checked regularly, so it probably wouldn't be great if I had to wait months to see a doctor. I'm assuming I need a referral from a doctor to get my INR checked (other than home testing). Can I find a cardiologist on my own or do I need a referral from a general practitioner first (that's how my HMO works with specialists)? What steps should I take before and after the move?

Please explain non-HMO healthcare in the USA as if I were a 5 year old.

 

[MdaPA]

I will be moving across the country soon to NYC where Kaiser doesn't exist and I don't really know how I should go about transferring my care. I will have a new insurance and I know I can find a new set of doctors through the new insurers portal or just call around asking for doctors that are in network.

It's critical to NOT let you current insurance expire before acquiring new insurance (i.e. don't have any gap in coverage).

But I've also heard there are wait times that are months long for new patients are many place.

Certainly depends on the doctor, specialty and practice.

I got a mechanical valve, take warfarin and get my INR checked regularly, so it probably wouldn't be great if I had to wait months to see a doctor. I'm assuming I need a referral from a doctor to get my INR checked (other than home testing).

Perhaps you can get a script from your current doctor, go to lab after you move and have the INR results sent back to them and managed by them until you find a new doctor? You just need to make sure if the lab at your new location would be in-network with your current insurance otherwise you might have to pay out-of-pocket. Obviously self-testing would be your best option.

Can I find a cardiologist on my own or do I need a referral from a general practitioner first (that's how my HMO works with specialists)?

Depends on your insurance and/or general practitioner. Some insurance, even HMO's, don't require referrals and some do. If going to any doctor/specialist is important to you and they are not "in-network" then make sure you find an insurance plan that covers out-of-network doctors (usually called a PPO).

 

[dornole]

Looking at docs on the insurance portals can be overwhelming and not a lot of info to go on, mine covered thousands of docs. My shortcut, which I actually learned because of my emergency valve situation wherein I was transferred from one hospital to a different hospital via ambulance, is:

1) figure out what the best hospital is in your new town (including heart hospital)

2) look for primary care docs and specialists are who are affiliated with that premier hospital (same health system)

After I left that hospital I had all new docs for both me and my kids, all much better than the ones I randomly chose online.

Since you are used to Kaiser I think another big health system will probably work for you - network of providers, but you will bring your own separate insurance and have more freedom. I like keeping my care in one health system because my electronic health records, etc are all in one spot for me to see online thru MyChart, all my docs, test results etc in one place.

Best of luck!

 

[dornole]

You can check your insurance to see if you need a referral for a specialist, and if not get on their calendar now your inr management and seamless services. I really think that for medical necessity reasons you should be able to arrange this.

 

[Chuck C]

I think the advice above to try to stay in Kaiser until you establish new coverage is good advice. If you get into a pinch and need warfarin refilled or need to get an INR lab, you can probably get this taken care of at an urgent care, which are all over the place now, especially in a place like NYC.

I've had to re-establish doctors a few times, due to moves and due to a doctor dying from Covid. At these times I have utilized urgent care when needed. Typically, I will check my insurance plan to find the list of urgent cares in network. I might check Yelp reviews to make sure that I'm going to one with a good reputation. Usually, you can get a same day appointment and they often take walk ins, although you could end up waiting a couple of hours if you just walk in. You will usually be seen by an MD or a nurse practitioner who can write prescriptions and give referrals.

Can I find a cardiologist on my own or do I need a referral from a general practitioner first (that's how my HMO works with specialists)?

It really depends on your insurance plan. I grew up with Kaiser and my parents had Kaiser until this year, so I am very familiar with them and yes they require a referral. My current plan does not require a referral. I can book an appointment with a cardiologist or even a surgeon consult without a referral. My parents, having both left Kaiser, now have plans which do not require referrals. If your new plan requires a referral, urgent care can refer you, as I noted above.

What steps should I take before and after the move?

As has been mentioned by MdaPA, you should not leave Kaiser until you have your new insurance plan. Also, I would have my current doctor load me up with a new warfarin prescription and several refills. My current cardiologist gives me a 3 month supply of warfarin at a time, plus refills that will take me out over a year. I also have him write me repeating labs, so that I can get my lipids or INR checked whenever I want, without needing to bother him all the time through the portal. I home test my INR, but will occasionally get a lab INR to compare it against my home meter. I also like to have my lipid panel done a few times per year. Kaiser uses their own lab, but hopefully if your doctor at Kaiser understands your situation with moving, he can write you up prescriptions and labs to be used outside the Kaiser system. Quest Diagnostics and Labcorp have labs all over the country and both have several labs in NYC. I prefer Quest, but a lab order for either of those labs should work for you. I would ask if they could write me a lab referral for INR that repeats monthly, if they will cooperate. If they won't write repeating labs, hopefully, they would write you at least one lab draw, giving you time to establish a new doctor relationship by the time the next lab is due. But, as noted above, in a pinch, urgent care should be able to meet your lab needs, as well as prescription refills.

Good luck with your move!

 

[3mm]

Years ago some pharmacies would only fill prescriptions from doctors within that state. I don't know if this is still an issue.

 

[Chuck C]

Years ago some pharmacies would only fill prescriptions from doctors within that state. I don't know if this is still an issue.

I believe that generally you can get out of state prescriptions filled for drugs which are not sedatives or stimulants- ie on the controlled medication list. Although, it may vary state by state.

This link has some information about this:

https://www.wellrx.com/news/can-i-fill-a-prescription-in-a-different-state/

 

[macvalve]

Thanks for all the replies, they're super helpful.

For home testing, do most of you need a doctor to order or authorize testing strips and then you buy them from some insurance approved seller?

 

[MdaPA]

For home testing, do most of you need a doctor to order or authorize testing strips and then you buy them from some insurance approved seller?

In the U.S, you can obtain your self-testing machine and supplies either on the 2nd market (e.g. ebay) or you can go through a monitoring service where they rent you a machine and send you supplies. No script or insurance needed if going through ebay but one is required for a monitoring service which works with your insurance and/or doctor.

There are pro's and con's of both.

Here are some prior discussions on this topic:
Home Testing since COVID?
Testing Strips for Roche CoaguChek XS
Anthem blue cross blue shield inr equipment
Home Testing Supplies in US