Medicare's new plan to reduce hospital overcrowding

You need to get a referral issued for outpatient care or day hospital treatment (if that's what the head nurse told you), because any referral they issue now will still be valid even after September 1st, 2013, provided you already have an appointment scheduled.

I'm really hoping they finally grant it to me at 9... right now, we're just stuck waiting on whether they'll approve it through an appeal, since everything is supposedly changing. Honestly, it actually terrified me... I had this gut feeling she just didn't want to give it to me, which is something I've truly never experienced from her before. Regardless, I made it clear to her: I am going to fight to get everything I'm entitled to and push this through... not just the referral, but the surgery itself.
I just don't understand why she refused to give me the referral today, or what on earth I could have possibly done differently to make her comply. It's not like I can go in there and try to teach a doctor how to do their job. How is a patient even supposed to carry themselves in a situation like this?

George Allen71 said:I'm really hoping they finally grant it to me at 9... right now, we're just stuck waiting on whether they'll approve it through an appeal, since everything is supposedly changing. Honestly, it actually terrified me... I had this gut feeling she just didn't want to give it to me, which is something I've truly never experienced from her before. Regardless, I made it clear to her: I am going to fight to get everything I'm entitled to and push this through... not just the referral, but the surgery itself.
I just don't understand why she refused to give me the referral today, or what on earth I could have possibly done differently to make her comply. It's not like I can go in there and try to teach a doctor how to do their job. How is a patient even supposed to carry themselves in a situation like this?

If a patient decides to confront a doctor who isn't doing what they're supposed to be doing,effectively threatening to go to the media and name names is an option. But honestly, forget about the medical board, the American Medical Association, or Medicare. 😂 Just because someone announced that things are changing on September 1st doesn't mean those rules apply right this second. 😠
Some doctors are truly bringing shame to their profession. If they're so afraid of being called out by Medicare, then they should just cancel their contracts and start working in private practice. Things like this genuinely infuriate me. I have my own doctor, but she won't even argue with me once she realizes that pushing back isn't the smart move. 🙂

Nicholas Myers said:No, melloworca6, that’s not quite right.

A referral with Code A currently refers to a specialist visit. On the updated paperwork, it will be renamed a "consultation review," but the function remains nearly identical—visiting a specialist's clinic for an initial exam or follow-up. The main change is that certain tests previously categorized under Code C will now be bundled under this code.

Nothing fundamental is shifting here.

Don't walk into your appointment expecting a full board of doctors.

Which specific tests are being included? I’ve gathered that specialists won't be allowed to issue internal referrals anymore—which has always been standard practice—nor will they be able to order follow-ups. Instead, everything will be decided by primary care physicians. It makes zero sense; it's as if we're suddenly pretending that family doctors possess an encyclopedic mastery of every niche medical specialty when, in reality, they often lack that specific depth...
I am living through a perfect, albeit frustrating, illustration of this madness right now. For months, I've been breaking out in these skin lesions on my arms and legs; they flare up, itch incessantly, and leave me feeling miserable, yet they eventually subside. Regardless, I have a fundamental right to know what is happening to my own body. My doctor refuses to give me a referral, dismissively telling me, "Oh, don't even bother applying anything, it'll pass on its own." When I explicitly ask for a dermatologist referral, he insists it isn't necessary. Now, I'm sitting here waiting for Monday, wondering: what happens if he still refuses? If this becomes the universal standard, we are all well and truly doomed. This is just one trivial, everyday example, but it serves as a grim harbinger of how much control we are losing.

Nicholas Myers said:I don't see much shifting for family doctors. It feels like the real impact will hit hospital specialists. Now, their diagnostic recommendations will actually be tracked. Up until now, the system just monitored how many referrals a GP issued.

Specialists will have to think twice before ordering unnecessary tests or follow-ups. Every recommendation they make is going on the record now.

As for chronic conditions—think diabetes, hypertension, asthma, or COPD—primary care has always handled them. The standard was to have at least 80% of those patients managed by a family doctor, with only a small fraction seeing specialists. They've been adjusting blood pressure meds or insulin doses for years, and they'll keep doing it.

That’s exactly what they fought for.

For rare or complex cases, they’ll still write the referrals and leave it to the specialists. I don't expect much change there. But there will be a shift for, say, high blood pressure patients who are used to visiting "their" specialist at the hospital every few months—people who know the specialist better than their own family doctor—just to get a "continue current therapy" note or a minor dosage tweak.

In your opinion, how often should someone with high blood pressure actually need to see a specialist? At the end of the day, if someone has been struggling with hypertension for fifteen years, I’d imagine they ought to undergo additional testing, like an ultrasound or something similar... yet most family doctors won't even bother measuring their blood pressure. Most of them, anyway. It seems we're all left having to rely entirely on our own home monitors.

Here’s a new article, though I honestly don't think they've broken any new ground here—it feels like everything in it has already leaked out somewhere else.> click.

My psychotherapist mentioned to me last week that since their rehabilitation program doesn't actually account for psychotherapy (much like how they wouldn't include physical therapy in a standard plan), it falls under the category of a regular psychiatric consultation. Since those are limited to three visits per year, anything beyond that means we'll be paying out of pocket $33.
Normally, you'd see a therapist once a week. If you skip vacations and holidays, that works out to about 45 sessions a year. So, if I'm paying for 42 of them at $100 each, that's roughly $1400 annually just for psychotherapy. It’s still technically cheaper than seeing a private practitioner—who usually charges $300 or more per session—but it feels incredibly silly. I mean, psychotherapy is its own established category, and this specific clinic is a premier referral center that has been doing this for 60 years... and now, all of a sudden, psychotherapy effectively doesn't exist? Unless, of course, the folks over at the psychiatric hospital manage to talk their way out of covering it.

Bit by bit, we are starting to look more and more like the USA (and not in a good way...).
It's honestly not surprising when you consider the fact that 35% of the population ends up subsidizing healthcare for 100% of the users. ☕
Personally, I'm one of those people who pays for the standard coverage plus supplemental insurance, and yet I still end up going to my neurologist privately and my gynecologist privately...

Kyle Lee7 said:My psychotherapist mentioned to me last week that since their rehabilitation program doesn't actually account for psychotherapy (much like how they wouldn't include physical therapy in a standard plan), it falls under the category of a regular psychiatric consultation. Since those are limited to three visits per year, anything beyond that means we'll be paying out of pocket $33.
Normally, you'd see a therapist once a week. If you skip vacations and holidays, that works out to about 45 sessions a year. So, if I'm paying for 42 of them at $100 each, that's roughly $1400 annually just for psychotherapy. It’s still technically cheaper than seeing a private practitioner—who usually charges $300 or more per session—but it feels incredibly silly. I mean, psychotherapy is its own established category, and this specific clinic is a premier referral center that has been doing this for 60 years... and now, all of a sudden, psychotherapy effectively doesn't exist? Unless, of course, the folks over at the psychiatric hospital manage to talk their way out of covering it.

Bit by bit, we are starting to look more and more like the USA (and not in a good way...).
It's honestly not surprising when you consider the fact that 35% of the population ends up subsidizing healthcare for 100% of the users. ☕
Personally, I'm one of those people who pays for the standard coverage plus supplemental insurance, and yet I still end up going to my neurologist privately and my gynecologist privately...

I have to admit, this is news to me. I’ve heard whispers about extra fees floating around, but I haven't seen anyone state this officially.

From what I understand, there are referrals for outpatient care, and psychotherapy definitely doesn't fall under the umbrella of a simple "consultation."

Furthermore, there is no regulation stating a limit on annual visits—the mention of three follow-ups usually refers to post-hospitalization check-ins within a six-month window. There is also no rule saying, for instance, that a GP can't refer someone to a psychiatrist ten times a year.

Those kinds of numbers are just hallway talk, unofficial chatter. Officially, I haven't seen a single document mandating a cap on annual psychiatric visits or a specific number of physical therapy sessions for any given diagnosis. 🤷

Jason Vaughn482 said:Which specific tests are being included? I’ve gathered that specialists won't be allowed to issue internal referrals anymore—which has always been standard practice—nor will they be able to order follow-ups. Instead, everything will be decided by primary care physicians. It makes zero sense; it's as if we're suddenly pretending that family doctors possess an encyclopedic mastery of every niche medical specialty when, in reality, they often lack that specific depth...
I am living through a perfect, albeit frustrating, illustration of this madness right now. For months, I've been breaking out in these skin lesions on my arms and legs; they flare up, itch incessantly, and leave me feeling miserable, yet they eventually subside. Regardless, I have a fundamental right to know what is happening to my own body. My doctor refuses to give me a referral, dismissively telling me, "Oh, don't even bother applying anything, it'll pass on its own." When I explicitly ask for a dermatologist referral, he insists it isn't necessary. Now, I'm sitting here waiting for Monday, wondering: what happens if he still refuses? If this becomes the universal standard, we are all well and truly doomed. This is just one trivial, everyday example, but it serves as a grim harbinger of how much control we are losing.

Specialists will still be able to issue internal referrals if the primary care physician sends the patient over with a referral marked C or D (and naturally, B).

They won't be allowed to issue internal referrals if the PCP sends a patient with an "A" designation on the referral.

If a patient arrives with an "A" designation, then yes—the specialist cannot issue an internal referral, cannot recommend a follow-up, cannot schedule the return visit, and cannot mandate any specific treatments or diagnostic tests. The primary care doctor actually has the right to deny or withhold anything the specialist suggests. However, that doctor then carries the liability if something goes wrong with the patient. Consequently, every PCP will think twice before following a specialist's advice or recommendation.

Now I'm just waiting for Monday. If they don't give it to me... what then? If that's how it goes, we're all doomed.

Even before this, your PCP wasn't strictly obligated to give you a referral. You couldn't force them to send you to, say, a dermatologist if they didn't see the need. Nothing has fundamentally changed regarding that authority.

If you can't find common ground with your PCP—if you're living in fear that they might actually try to treat something (like strep throat or a skin lesion) and you feel they lack the skills to do anything beyond handing out a script (which is often wrong anyway)—then there is only one solution: find a new doctor.

Jason Vaughn482 said:In your opinion, how often should someone with high blood pressure actually need to see a specialist? At the end of the day, if someone has been struggling with hypertension for fifteen years, I’d imagine they ought to undergo additional testing, like an ultrasound or something similar... yet most family doctors won't even bother measuring their blood pressure. Most of them, anyway. It seems we're all left having to rely entirely on our own home monitors.

Same answer as before—find a different doctor.

Nicholas Myers said:I have to admit, this is news to me. I’ve heard whispers about extra fees floating around, but I haven't seen anyone state this officially.

From what I understand, there are referrals for outpatient care, and psychotherapy definitely doesn't fall under the umbrella of a simple "consultation."

Furthermore, there is no regulation stating a limit on annual visits—the mention of three follow-ups usually refers to post-hospitalization check-ins within a six-month window. There is also no rule saying, for instance, that a GP can't refer someone to a psychiatrist ten times a year.

Those kinds of numbers are just hallway talk, unofficial chatter. Officially, I haven't seen a single document mandating a cap on annual psychiatric visits or a specific number of physical therapy sessions for any given diagnosis. 🤷

Personally, I'm hoping things get ironed out in the end, though it seems obvious that the healthcare system is facing a financial meltdown. Things that used to be taken for granted now require out-of-pocket payments.

I received this information from my therapist and one other person. It’s clear that a lot of this remains vague and poorly defined.
In any case, even if they approve certain therapies, there will be a limit. It won't be like what I've heard—that some people go on therapy for twenty years. Look, everyone needs help, but there has to be some logic to it. You know roughly how long a course of therapy lasts, and while we're talking about several years, twenty?!

And of course, there's always the potential for abuse, but I don't want to fan the flames by making that the focus right now...

Amanda Chavez27 said:Here is the question I am trying to get an answer to.
I have schizophrenia and receive treatment at the Mayo Clinic.
I’ve completed four psychiatric evaluations following my hospital stays, as I have been working under a medication regimen prescribed by my psychiatrist at Mayo Clinic, which my primary care physician then implements.
I need to know if I will continue seeing specialists at Mayo Clinic starting September 1st, or if my primary care doctor will take over those follow-ups.

It’s not four—it’s three follow-up exams. And look, the frequency of those subsequent check-ups isn't some fixed rule; it’s entirely up to your medical association. Basically, they hold all the cards. If they decide you need to be in for testing fifty times a year, they can send you right back through those doors. It's their call.

Elizabeth Fowler46 said:Is there going to be any shift regarding the other doctors in primary care? Basically, can my gynecologist still write me prescriptions or lab referrals, or is that all going to have to go through the AMA now?

It stays exactly the same.

Kyle Lee7 said:1. Well, I guess they "don't" have to then...
In my case, a neurologist—Professor Brinar—actually prescribed the exact dose I had discovered myself online and started taking: 5000 IU. And yes, there is evidence suggesting that patients with MS seem to deal with Vitamin D3 metabolism issues.
So, clearly, neurologists do know what's up.

2. I know exactly how an acute asthma attack is treated because I've been dealing with this since I was six years old, and now I'm nearly forty. But as I mentioned before, this wasn't an acute attack; it was a flare-up of the underlying condition. It wasn't quite "emergency room" level, but it was certainly "pulmonologist" level. I wanted to know their take—was this a new allergy, maybe my medication isn't working anymore, could it be an infection, or something else entirely?
The problem was, I couldn't actually see a pulmonologist because the wait time is a month. By the time that month passed, I didn't need them anymore.

I should clarify: my asthma is very well controlled. The only Ventolin I have at home expired back in 2007, so that's useless. I don't even take Flixotide or Serevent anymore; I just take one Singulair a day. When I first started, I was on 2x Flixotide and Serevent in the morning and again at night. Eventually, we managed to taper down to just that single Singulair. And that entire process happened under the close supervision of a pulmonologist, not some general practitioner or an ER doctor. That's precisely why—because we reached such a great state through careful monitoring and tapering—it worries me when I notice things starting to slip. Naturally, I want to see the specialist who manages my care, someone who would find it useful to see and hear about the situation right when the decline begins—to understand *why* it's happening and whether I'll need to move back to a stronger regimen.

So, my question remains: who needs a pulmonologist, and when?
Because based on your comments, it sounds like I'll never need one again. 🤷

Can someone please find me an official recommendation from a neurological association—or honestly, anything that isn't just some random study on Vitamin D levels in MS? Look, I’m not saying we should flat-out ignore the research, but that kind of data is strictly for neurologists to interpret, not for general practitioners or primary care doctors to play doctor with.
You can try to handle all of this through your primary care physician first—maybe they’ll suggest bumping up your inhaled steroid dosage or something similar. But look, if you don't see any actual improvement after that, don't waste your time. Go straight to a pulmonologist.

George Allen71 said:I have a question... I'm based out of the NYC area, and I need to undergo a surgical procedure that can only be performed at the Mayo Clinic. When I tried to get my preliminary testing done locally in the city, they basically told me no... because they want everything handled within their own hospital system. I've been scheduled for an outpatient appointment at 9:00 AM to get all my tests completed. Today, I went to see my primary care physician to ask for the referral... she told me to just come back at the beginning of September when the actual procedure date rolls around, because who knows what will happen by then?! She refused to give me the referral now, even though any referral she issued would likely be valid for about 30 days anyway. What is the deal here? Was she allowed to act that way? I called the Mayo Clinic and the head nurse confirmed that I am indeed on the schedule for outpatient services for that date at 9:00. Does my doctor have the right to refuse to give me the referral right now... or perhaps even later in September if four different specialists from the Mayo Clinic insist on performing the tests themselves because the procedure is so specialized and only their specific team handles it?

Honestly, it feels like you're making a mountain out of a molehill.

Jason Vaughn482 said:In your opinion, how often should someone with high blood pressure actually need to see a specialist? At the end of the day, if someone has been struggling with hypertension for fifteen years, I’d imagine they ought to undergo additional testing, like an ultrasound or something similar... yet most family doctors won't even bother measuring their blood pressure. Most of them, anyway. It seems we're all left having to rely entirely on our own home monitors.

If a specialist is handling the processing, then it's entirely up to whatever that specialist decides.
As for the supplemental testing, everything should be available through the local health department (CBC, glucose, CRP, AST, ALT, GGT, creatinine, urea, urate, K, Na, creatinine clearance, lipid panel)
including fundus exams
and X-rays.
In addition to what?

Kyle Lee7 said:Personally, I'm hoping things get ironed out in the end, though it seems obvious that the healthcare system is facing a financial meltdown. Things that used to be taken for granted now require out-of-pocket payments.

I received this information from my therapist and one other person. It’s clear that a lot of this remains vague and poorly defined.
In any case, even if they approve certain therapies, there will be a limit. It won't be like what I've heard—that some people go on therapy for twenty years. Look, everyone needs help, but there has to be some logic to it. You know roughly how long a course of therapy lasts, and while we're talking about several years, twenty?!

And of course, there's always the potential for abuse, but I don't want to fan the flames by making that the focus right now...

schizophrenia, psychosis, zero points?
It's honestly no wonder the healthcare system is in, well, let's just say a bad spot, when patients are busy undermining each other. Someone could easily look at you and ask why you're showing up every single week when once a month (or even every two months) for a check-up would do just fine. ☕

A few days ago, a primary care physician refused to issue a referral for a young patient with Type 1 diabetes to see an ophthalmologist-retinologist—the specialist who normally monitors his retina—claiming they simply couldn't due to some new system model or similar bureaucratic nonsense.

I don't have all the specifics regarding this particular case, and I suspect the patient hasn't actually been diagnosed with retinopathy yet. However, given the primary diagnosis, he really should be seeing a retinologist for routine monitoring to catch any changes, perhaps once a year or at least once every two years.
That is the standard clinical recommendation for anyone managing diabetes. https://www.cardiosmart.org/~/media/...en/zu1686.ashx

copperlynx22 said:A few days ago, a primary care physician refused to issue a referral for a young patient with Type 1 diabetes to see an ophthalmologist-retinologist—the specialist who normally monitors his retina—claiming they simply couldn't due to some new system model or similar bureaucratic nonsense.

I don't have all the specifics regarding this particular case, and I suspect the patient hasn't actually been diagnosed with retinopathy yet. However, given the primary diagnosis, he really should be seeing a retinologist for routine monitoring to catch any changes, perhaps once a year or at least once every two years.
That is the standard clinical recommendation for anyone managing diabetes. https://www.cardiosmart.org/~/media/...en/zu1686.ashx

True, diabetics need an eye exam at least once a year. If you’re dealing with other diagnoses on top of diabetes, then it's an absolute MUST to get checked annually... speaking from experience. 😁)
I honestly don't get it. If the patient is following all the protocols themselves, HOW could Medicare even turn down the referral...

Brandon Lopez6 said:schizophrenia, psychosis, zero points?
It's honestly no wonder the healthcare system is in, well, let's just say a bad spot, when patients are busy undermining each other. Someone could easily look at you and ask why you're showing up every single week when once a month (or even every two months) for a check-up would do just fine. ☕

I think you misunderstood my point. 😉
I am talking about psychotherapy for neurosis. Specifically, at a psychiatric hospital. These aren't just routine check-ups.
As far as I know, psychoanalytic psychotherapy isn't typically used for schizophrenia or psychosis.
Psychoanalytic psychotherapy usually consists of a 45-minute conversation once a week. It's indicated for things like stress, anxiety, or depression...
That kind of therapy lasts on average five years, after which it's considered complete. So, there really isn't any sense in people staying on that kind of therapy for twenty years at the expense of Medicare.

I honestly don't quite get this. I mean, a general practitioner shouldn't really be performing a retinal exam on their own. Maybe she was just following guidelines to refer him to a standard ophthalmologist instead? So, he had a fixed appointment scheduled for a specific day with a retinologist, and she just flat-out refused to give him the referral? I actually missed my annual checkup this year because I was looking after my mom while she was sick, so I'm planning to reschedule toward the end of this month. I need to grab a referral before then, too. I really hope they'll just give it to me. It’s just... four whole years ago, I had to undergo laser treatment because of a retinal detachment. One thing though—at the facility where I go for my follow-ups, they call it the Laser Suite, yet most people there haven't even had laser surgery; they're just there for routine checks. I guess maybe they try to direct people to a regular outpatient clinic first, and then if things take a turn for the worse, they send them to a specialist retinologist. In my case, a private ophthalmologist was the one who caught the retinal detachment, and he's the one who referred me to the hospital retinologist four years ago. Usually, the wait times at the standard clinics aren't nearly as bad as they are with the specialists, and from what I've heard from people who went last year, they still dilate your pupils and perform the exact same exams.

Kyle Lee7 said:I think you misunderstood my point. 😉
I am talking about psychotherapy for neurosis. Specifically, at a psychiatric hospital. These aren't just routine check-ups.
As far as I know, psychoanalytic psychotherapy isn't typically used for schizophrenia or psychosis.
Psychoanalytic psychotherapy usually consists of a 45-minute conversation once a week. It's indicated for things like stress, anxiety, or depression...
That kind of therapy lasts on average five years, after which it's considered complete. So, there really isn't any sense in people staying on that kind of therapy for twenty years at the expense of Medicare.

So, the assumption is they go once a week for five years, right?
4x12x5=240

But most people actually go once a month.
1x12x20=240

The total number of sessions ends up being the same. And honestly, even if we ignore the fact that everyone is different and plenty of people just try to "patch things up" only for the illness to come back... in my book, you shouldn't be looking at averages when it comes to psychiatry.

mistyjackal842 said:I honestly don't quite get this. I mean, a general practitioner shouldn't really be performing a retinal exam on their own. Maybe she was just following guidelines to refer him to a standard ophthalmologist instead? So, he had a fixed appointment scheduled for a specific day with a retinologist, and she just flat-out refused to give him the referral? I actually missed my annual checkup this year because I was looking after my mom while she was sick, so I'm planning to reschedule toward the end of this month. I need to grab a referral before then, too. I really hope they'll just give it to me. It’s just... four whole years ago, I had to undergo laser treatment because of a retinal detachment. One thing though—at the facility where I go for my follow-ups, they call it the Laser Suite, yet most people there haven't even had laser surgery; they're just there for routine checks. I guess maybe they try to direct people to a regular outpatient clinic first, and then if things take a turn for the worse, they send them to a specialist retinologist. In my case, a private ophthalmologist was the one who caught the retinal detachment, and he's the one who referred me to the hospital retinologist four years ago. Usually, the wait times at the standard clinics aren't nearly as bad as they are with the specialists, and from what I've heard from people who went last year, they still dilate your pupils and perform the exact same exams.

Exactly. She didn't give him a referral because he hasn't been diagnosed with diabetic retinopathy yet (he's still 🙄).
That said, it’s vital to emphasize that diabetics should see an ophthalmologist who specializes specifically in diabetic eye disease.

mistyjackal842 said:I honestly don't quite get this. I mean, a general practitioner shouldn't really be performing a retinal exam on their own. Maybe she was just following guidelines to refer him to a standard ophthalmologist instead? So, he had a fixed appointment scheduled for a specific day with a retinologist, and she just flat-out refused to give him the referral? I actually missed my annual checkup this year because I was looking after my mom while she was sick, so I'm planning to reschedule toward the end of this month. I need to grab a referral before then, too. I really hope they'll just give it to me. It’s just... four whole years ago, I had to undergo laser treatment because of a retinal detachment. One thing though—at the facility where I go for my follow-ups, they call it the Laser Suite, yet most people there haven't even had laser surgery; they're just there for routine checks. I guess maybe they try to direct people to a regular outpatient clinic first, and then if things take a turn for the worse, they send them to a specialist retinologist. In my case, a private ophthalmologist was the one who caught the retinal detachment, and he's the one who referred me to the hospital retinologist four years ago. Usually, the wait times at the standard clinics aren't nearly as bad as they are with the specialists, and from what I've heard from people who went last year, they still dilate your pupils and perform the exact same exams.

I assume you don't have diabetic retinopathy yourself; that's a much more specific diagnosis.

The goal is to catch it in its earliest stages, when there are no obvious changes—just perhaps a few microaneurysms that might remain stable for years. Standard ophthalmologists often miss these; quite simply, they haven't seen enough fundus images of that nature.

In patients with diabetes, these changes progress very slowly. Through regular monitoring, one can prevent the proliferative stage, which is when everything tends to spiral out of control for a diabetic. We aren't talking about a single rupture, but rather constant, tiny hemorrhages that trigger the growth of new, fragile, and faulty vessels, which eventually burst repeatedly and lead to total blindness.

As for your situation, I suspect they won't deny you a follow-up referral since you already have a documented history involving the retina.

Thanks so much for the reply. Honestly, I’ve actually had an experience where a regular ophthalmologist completely missed a retinal tear. I ended up seeing a second specialist privately, and only then did they catch the rupture and refer me to a retina specialist at the hospital. I really think it’s best if that person with diabetes you mentioned goes straight to a retina specialist for an exam. They just have so much more specialized experience. That said, I suppose you can still find a decent general ophthalmologist who knows their stuff regarding the retina. I don't have diabetes myself, but my grandfather did—he was diagnosed later in life, and it really took a toll on his vision. He even went in for laser treatment, but unfortunately, he still ended up going blind. Personally, I’m terrified of lasers, even though I don't go to that specific hospital in Chicago that he used. It’s just a huge fear for me, knowing there's a laser sitting right there next to the doctor.

Am I understanding this correctly?
If I already have a specialist at the general hospital, does that mean I can't get a referral to see someone in Chicago?
I'm talking about follow-up appointments with an oncologist I've been seeing for five years now, and I would really love to stay with him.
If I'm forced to do my checkups in a place like Des Moines... that's going to be awful. It's hard to believe they only have one oncologist working there, and even then, he was mostly being covered by an internist. 😕
It isn't that they wouldn't accept an oncologist, but from what I've heard, they simply don't have any available.