View Full Version : geriatricians
Does anyone here use a geriatrician as their primary care doctor? I guess I qualify age wise, and I am so dissatisfied with my primary care doctor. Does anyone go to a geriatrician, and what has been your experience?
My mother looked into one but didn't like that they come to your house. She prefers to go to the doctor's office and not worry if her house is not neat and clean enough (in her mind).
My mother looked into one but didn't like that they come to your house. She prefers to go to the doctor's office and not worry if her house is not neat and clean enough (in her mind).
Ooh, I didn't realize they come to your house--that would not appeal to me, either.
Not all geriatricians do! My MIL went to one, and he was just like any other family practice doctor, only he talked like Mr. Rogers to his patients.
Not all geriatricians do! My MIL went to one, and he was just like any other family practice doctor, only he talked like Mr. Rogers to his patients.
That might be good or not so good,I guess. I realize I dislike my current doctor so much that I don't want to go to her or talk to her or have her anywhere near me, so I have to find another.
Tybee, we are in the same situation. Really dislike our primary care doctor and her NP is not much better. I feel more like she is being pressured to meet some statistical measure instead of listening to the patients. They both have issues with the electronic record keeping needs and we have few if any issues. Husband gets clearly different instructions from his cardiologist.
Mom's doctor is not good either. She was having issues with losing old friends (happens a lot when you are 90) and the doctor wanted her on Xanax. Way way out of line.
Don't know that I want to go to the doctor again. They now ask you if you are vaxxed against covid, enter a code in your electronic medical record that follows you everywhere with your vax status so the government can track you, and bill your insurance for vax counseling.
Yes, they do want to track you if you live in Massachusetts.
https://www.bostonherald.com/2022/11/18/massachusetts-dph-google-secretly-installed-covid-spyware-onto-1m-phones-lawsuit-says/
How far is your nearest teaching hospital? There may be more of a choice of doctors near an academic center, at least a choice of good ones. If you don't have to go to the doctor much, it might be worth it to travel. If you got sick, you'd have to go to the hospital anyway, and your doctor would be there.
Count me among those who are not happy with their local family practitioners. sweetana, at least your husband has a cardiologist. I can't even get my NP to refer me to one. (I don't even have an MD because there's only one up here). My next step is to just start going into Burlington for check-ups.
iris lilies
3-19-23, 10:05am
How far is your nearest teaching hospital? There may be more of a choice of doctors near an academic center, at least a choice of good ones. If you don't have to go to the doctor much, it might be worth it to travel. If you got sick, you'd have to go to the hospital anyway, and your doctor would be there.
Count me among those who are not happy with their local family practitioners. sweetana, at least your husband has a cardiologist. I can't even get my NP to refer me to one. (I don't even have an MD because there's only one up here). My next step is to just start going into Burlington for check-ups.
Catherine, were you the person who whose physician didn’t order a standard blood panel annually? Is that true or did I dream that?
I just had an annual doctor’s visit this week and I’m fine with my direct care physician’s practice. I haven’t seen the actual doctor in two years. I deal with her nurse practitioners. I COULD make an appointment with her if it was important to me, but it’s not.
Teaching hospital is 40 minutes away. But they are very covidian.
Some of my fellow activists are saying we need to build a whole parallel society because the one we have is so broken. They are doing things like going to first aid classes in order to avoid the medical system if possible.
I'd be happy to find a good family practice doctor let alone a geriatrician but it seems like MDs other than well-paid specialists have disappeared. Lots of nurse practitioners but they are usually young and female so an older male like DH isn't comfortable going to see them.
Catherine, were you the person who whose physician didn’t order a standard blood panel annually? Is that true or did I dream that?
Yup, that's me. They ration out the blood tests as if you were asking for that last sip of water on a lifeboat. I have been here 5 years and have yet to get a complete CBC. All I've gotten is two lipid panels and a couple of random tests like a Vitamin D eat and something else.
I understand you can have comprehensive tests done by private labs at reasonable rates, if your doctor isn't cooperative.
Teacher Terry
3-19-23, 6:41pm
I love my doctor and have been seeing her for 26 years. She is in her late 50’s. She orders blood work yearly.
iris lilies
3-19-23, 7:04pm
Yup, that's me. They ration out the blood tests as if you were asking for that last sip of water on a lifeboat. I have been here 5 years and have yet to get a complete CBC. All I've gotten is two lipid panels and a couple of random tests like a Vitamin D eat and something else.
Like Terry’s doctor, my doctor orders bloodwork yearly. I do not understand why yours would not although I will say that the only important parts of my blood test were the lipid test and the vitamin D test, both of which required subsequent medication.
I must have a Cadillac plan on top of Medicare. I call the shots on specialists at least we choose and most are with BCBS. Hardest thing is getting an appointment. Get the blood tests, hubby gets psa, etc. yearly. We live in a town with an overabundance of hospitals and doctors. We also have a big teaching hospital, VA hospital, Riley Hospital for Children and on and on.
iris lilies
3-19-23, 7:27pm
I must have a Cadillac plan on top of Medicare. I call the shots on specialists at least we choose and most are with BCBS. Hardest thing is getting an appointment. Get the blood tests, hubby gets psa, etc. yearly. We live in a town with an overabundance of hospitals and doctors. We also have a big teaching hospital, VA hospital, Riley Hospital for Children and on and on.
is the type of insurance what determines whether Catherine gets a blood test or not? A privately funded blood test is always an option as Jane points out.
Last summer I paid around $150 for an environmental allergy test, which was not covered by insurance. Last week I paid $385 for a food allergy test.
I would be surprised by a doc that didn’t at least check lipids and a1c annually. I just had my annual wellness visit Friday and on top of those he also ordered some newer lipid test that is supposedly better. That was probably because my cholesterol is above ‘ideal’.
I went through Ulta lab tests to order my own tests. I was trying out some dietary changes for elevated cholesterol, and wanted quicker feedback than my annual exam. It was under $50 for lipids panel.
rosarugosa
3-20-23, 6:01am
I went through Ulta lab tests to order my own tests. I was trying out some dietary changes for elevated cholesterol, and wanted quicker feedback than my annual exam. It was under $50 for lipids panel.
Herb: How effective were the dietary changes? My MD is suggesting a statin for me, but I would like to avoid that route.
Like Catherine's, my doctor seems to ration out tests so that I suspect she is given a certain number of them to allocate.
My primary care suggested lecithin and red rice yeast capsules for my cholesterol. They have made a small difference in my borderline numbers. I told her I would NOT take statins. She's pretty open to trying natural things before drugs. She'll order labs without a problem. I keep hoping she doesn't retire!!
catherine
3-20-23, 10:15am
Like Catherine's, my doctor seems to ration out tests so that I suspect she is given a certain number of them to allocate.
Also I think my doctors are hung up on "medically necessary" and maybe so far Medicare hasn't provided guidelines on annual comprehensive blood draws. So they won't get reimbursed if a seemingly healthy person with no symptoms demands a full blood test. That's my suspicion.
Jane, I have considered going to a lab and paying on my own. But last summer I applied for a term life insurance policy and in order to qualify for the premium rate I had to get a blood test that they paid for. I did qualify for the premium rate, so I'm fine for a little while. Next year I'll ask for another one from my HCP and see what she says.
My primary care suggested lecithin and red rice yeast capsules for my cholesterol. They have made a small difference in my borderline numbers. I told her I would NOT take statins. She's pretty open to trying natural things before drugs. She'll order labs without a problem. I keep hoping she doesn't retire!!
You could look into berberine, also. Personally, I couldn't care less about cholesterol, but I'm assuming my triglycerides are suitably low.
Herb: How effective were the dietary changes?
I was able to bring my A1C from pre diabetic to normal and triglycerides down pretty quickly - didn't touch my LDL. When I've gone on reduced fat diets in the past, my liver just makes up the difference. My Dad and all siblings have elevated cholesterol, but no heart disease so far in my family.
frugal-one
3-20-23, 4:30pm
I was able to bring my A1C from pre diabetic to normal and triglycerides down pretty quickly - didn't touch my LDL. When I've gone on reduced fat diets in the past, my liver just makes up the difference. My Dad and all siblings have elevated cholesterol, but no heart disease so far in my family.
What did you do to make such a marked change?
What did you do to make such a marked change?
Reduced the daily glass of wine with dinner to once in a while, and cut out sweets for a while. I need to have my numbers retested, as I am trying to find a happy medium between "cut everything fun out" and "life is short, eat dessert". :)
frugal-one
3-20-23, 9:50pm
Thanks herbgeek. Also Jane… definitely gaining to check out berberine!
Thanks herbgeek. Also Jane… definitely gaining to check out berberine!
I've had no experience with it, but I keep hearing about it.
I decided to take Medicare up on the free annual wellness visit with a primary doc this week. It will be interesting to see what that consists of. I know they will be stuck on whether I've had all the old people shots and tests. I'm a non-compliant patient where that's concerned.
I decided to take Medicare up on the free annual wellness visit with a primary doc this week. It will be interesting to see what that consists of. I know they will be stuck on whether I've had all the old people shots and tests*. I'm a non-compliant patient where that's concerned.
*I call that the geriatric death-spiral cocktail.
There is plenty of online information on statins from recognized medical sources like the Harvard School of Medicine, the Mayo Clinic, Lancet, JAMA, and even AARP and NPR to make a personal decision. They all share similar conclusions. Step outside of the core medical community and you're likely to get different fringe opinions, just like Covid vaccinations. Sort of comes down to who you trust the most.
There is plenty of online information on statins from recognized medical sources
Studies that focus on men, yes. There are way fewer studies that include women, and many of those are inconclusive as to whether statins are effective for women. Lowering LDL doesn't seem to have a strong correlation with reduced cardiovascular events for women.
Studies that focus on men, yes. There are way fewer studies that include women, and many of those are inconclusive as to whether statins are effective for women. Lowering LDL doesn't seem to have a strong correlation with reduced cardiovascular events for women.
That could be something for people to look into. I'm just saying the information is out there and there are a lot of myths that may or may not be true. Everyone has a choice and hopefully it's based on correct information, and it's out there. I read one of the Amazon books hammering statins, can't recall the name, maybe the truth about statins or something, but I didn't buy it. That was not my trusted source.
My humble personal opinion is that a decision should be based on an overal cardiovascular risk. Younger people, people with a healthy life style and diet, reasonable blood pressure, and other basic health markers like weight or what ever could probably put up a strong argument against statins. As we get older some of those things start to slip unavoidably and it might be time. It might also include family genetics and histories of cardio vascular events. And anyone with a previous cardiovascular event should probably be on statins, unless they want to take the addition risk of a second event. That was my conclusion after looking into it.
iris lilies
3-21-23, 9:17pm
That could be something for people to look into. I'm just saying the information is out there and there are a lot of myths that may or may not be true. Everyone has a choice and hopefully it's based on correct information, and it's out there. I read one of the Amazon books hammering statins, can't recall the name, maybe the truth about statins or something, but I didn't buy it. That was not my trusted source.
My humble personal opinion is that a decision should be based on an overal cardiovascular risk. Younger people, people with a healthy life style and diet, reasonable blood pressure, and other basic health markers like weight or what ever could probably put up a strong argument against statins. As we get older some of those things start to slip unavoidably and it might be time. It might also include family genetics and histories of cardio vascular events. And anyone with a previous cardiovascular event should probably be on statins, unless they want to take the addition risk of a second event. That was my conclusion after looking into it.
A lifetime of testosterone could yield different risk factors from a lifetime of much less testosterone. Women may be different from men.
A lifetime of testosterone could yield different risk factors from a lifetime of much less testosterone. Women may be different from men.
Yup. I would assume the mainstream studies would take gender into consideration and they would specify and inquiring minds would know. A person can certainly speculate. Maybe the risk is more or maybe less? It does seem like women are catching with men for cardiovascular risk.
iris lilies
3-21-23, 9:50pm
Yup. I would assume the mainstream studies would take gender into consideration and they would specify and inquiring minds would know. A person can certainly speculate. Maybe the risk is more or maybe less? It does seem like women are catching with men for cardiovascular risk.
The posters above have said that studies on women are inconclusive. There aren’t that many studies. I don’t know if true because I don’t follow that stuff but I’ve heard it over and over.
I read your post as though you assume the data is there. We are telling you the data is not there.
The posters above have said that studies on women are inconclusive. There aren’t that many studies. I don’t know if true because I don’t follow that stuff but I’ve heard it over and over.
I read your post as though you assume the data is there. We are telling you the data is not there.
Not a problem. I'm not assuming anything and I don't know where people have or have not looked. As long as people have done some independent looking into reliable sources instead of relying on rumor, web posts, or myth, I'm fine. Actually I'm fine otherwise, too. I've made my own conclusions, as above.
I'm actually fine if people refuse all medications and spin the wheel of fortune. It's not my life and I'm only explaining my logic.
frugal-one
3-21-23, 10:08pm
That could be something for people to look into. I'm just saying the information is out there and there are a lot of myths that may or may not be true. Everyone has a choice and hopefully it's based on correct information, and it's out there. I read one of the Amazon books hammering statins, can't recall the name, maybe the truth about statins or something, but I didn't buy it. That was not my trusted source.
My humble personal opinion is that a decision should be based on an overal cardiovascular risk. Younger people, people with a healthy life style and diet, reasonable blood pressure, and other basic health markers like weight or what ever could probably put up a strong argument against statins. As we get older some of those things start to slip unavoidably and it might be time. It might also include family genetics and histories of cardio vascular events. And anyone with a previous cardiovascular event should probably be on statins, unless they want to take the addition risk of a second event. That was my conclusion after looking into it.
We came to entirely different conclusions. After researching, you could not pay me enough to take a statin. herbgeek and I have been reading the same information evidently.
We came to entirely different conclusions. After researching, you could not pay me enough to take a statin. herbgeek and I have been reading the same information evidently.
I'm glad you have found the answer. I assume your info was from reliable sources and possibly even peer reviewed. Or heaven forbid, a real in person doctor who knows your personal medical history and current state of health. I don't know what you've been reading and quite honestly barely care. It's your wheel of fortune.
Cancer, heart disease and stroke are the top causes of death in the US, and regardless of medications, one or the other is likely to get most of us. Nothing we do is going to prevent that. It's just a matter of sooner or later.
I have had some negative experiences with prescribed drugs (Cipro for one) that spooked me so I remain very cautious about taking anything - even aspirin. It's definitely a personal decision and not made any easier with all the "info" out there. Anytime I read about a study proclaiming the benefits of a certain drug, I check to see who paid for the research.
I resisted a statin until the last year or two and put up some of the same arguments. My cholesterol had gradually drifted a bit higher than border line. I have a concierge medical doctor and each year I get a full comprehensive blood panel from the Cleveland Clinic. One of the tests they do is supposed to indicate the degree of plaque build up in the arteries. Mine was in what they called the low red zone for atherosclerosis which is an indicator of heart disease and stroke risk, in spite of my healthy lifestyle. I also have strokes and heart disease in my family history. Nearly all of my older relatives on my mother's side had died of one or the other. There's no good way to die, but strokes are especially nasty and people can linger disabled for years in nursing homes. I know from experience.
My last blood panel showed the plaque build up indicator had come down to the low yellow, most likely due to the statin and cholesterol is now good. My doctor also referred me to some of the best medical studies, he thought, so I could look things up myself. I had not had any side effects that I know of and get a liver enzyme test every six months. My insurance pays for everything. Some people cannot tolerate some common statins and there are alternatives.
Everyone here seems to talk about some study or another. It really doesn't take much to google statins and get a whole list of references from common respected medical journals. I don't wish to argue any point, but do wish for everyone to stay healthy in the best way possible, which is why I've been a little persistent in discussing.
So that's my story. End of my input.
My partner was prescribed statins, and subsequently suffered "polymyalgia rheumatica," (which apparently means "we don't know why you hurt all over") and so his doctor, in his infinite wisdom, prescribed him a year-long course of steroids to combat it. Muscle pain, up to and including rhabdomyolysis, is a well-documented side effect of statins--which according to actual medical papers I've read, have a number needed to treat of over 100, and may extend a given old man's life a couple of months. They only provide known support to middle-aged men who have had previous heart attacks, and no benefit to women at all. (But boy, howdy are the newer ones profitable!)
If being skeptical of our medicine-for-profit system makes me a crazy conspiracy theorist, I'm happy to wear the label.
I have had some negative experiences with prescribed drugs (Cipro for one) that spooked me so I remain very cautious about taking anything - even aspirin. It's definitely a personal decision and not made any easier with all the "info" out there. Anytime I read about a study proclaiming the benefits of a certain drug, I check to see who paid for the research.
The floxacins are notorious for causing harm. I guess they're indicated for plague, but often prescribed for minor ailments. I was prescribed one of them some 30 years ago, and I was lucky--it only wiped out my microbiome, apparently. That was my last prescription.
I'm like you--except I allow myself a couple of aspirin daily, for now.
iris lilies
3-22-23, 1:08pm
I take a statin drug and have no problem. I know to watch our for muscle pain. My liver function is tested annually.
littlebittybobby
3-22-23, 2:01pm
Okay--No Muscles, No pain. But yeah---I do not take statins, and I hurt all over, at all times. Except, when I am exerting myself. Then, I don't feel so bad.
Hope that helps you some.
Okay--No Muscles, No pain. But yeah---I do not take statins, and I hurt all over, at all times. Except, when I am exerting myself. Then, I don't feel so bad.
Hope that helps you some.
That sounds familiar...:~)
frugal-one
3-22-23, 4:25pm
IL… Muscle pain is not the only side effect….diabetes, glaucoma, leukemia are some of the things I remember from when when I gave a presentation on the subject.
iris lilies
3-22-23, 4:29pm
IL… Muscle pain is not the only side effect….diabetes, glaucoma, leukemia are some of the things I remember from when when I gave a presentation on the subject.
I did not say “muscle pain is the only side effect.”
frugal-one
3-22-23, 4:30pm
[QUOTE=iris lilies;422818]I did not say “muscle pain is the only side effect.”[/QUOT
You indicated that is what you look out for…
Teacher Terry
3-22-23, 4:43pm
Statins negatively impact cognitive functioning. You couldn’t pay me to take one. They are only effective for men with previous heart attacks. If you read the studies they harm more people than help yet doctors still recommend them.
Statins negatively impact cognitive functioning. If you read the studies they harm more people than help yet doctors still recommend them.
Could you point out a reference. I'd be interested. I seem to be ok so far but maybe I just don't know it.
Teacher Terry
3-22-23, 4:59pm
Roger, a few years ago I researched studies in Pub Med but didn’t keep them.
Roger, a few years ago I researched studies in Pub Med but didn’t keep them.
Thanks. I don't trust all pubmed documents and doubt I'll hunt it down without more information. Anything from JAMA or the Lancet? Harvard School of Medicine or the Mayo Clinic?
Among all the commonly prescribed drugs the ones I would absolutely refuse are anti depressants. But research could change my mind if I still have cognitive function.
Both my FIL and his brother became diabetic after taking statins for a few years. It was just odd since they were both slender.
Both my FIL and his brother became diabetic after taking statins for a few years. It was just odd since they were both slender.
I am pretty sure that is one of the risks I have read about. I'm not sure how common it is. I think any prescription drug carries risk. At last that's what the TV says.
On the topic of old people and drugs, my 88yo MIL is now on 13 drugs - blood thinners, statins, cholesterol, anti-anxiety, anti-depressant, blood pressure, antibiotics....She is alive and cognitive mostly but sits in a chair all day unable to move at her assisted living facility. Makes me crazy that is even allowed.
On the topic of old people and drugs, my 88yo MIL is now on 13 drugs - blood thinners, statins, cholesterol, anti-anxiety, anti-depressant, blood pressure...She is alive and cognitive but sits in a chair all day in a stupor. Sad that is even allowed.
I'm not certain of the legal issues, but it might be possible for a person who has the right legal document to order all of those be ceased? Otherwise medical treatments are her choice if she is aware enough to made those decisions. I don't think anyone forces people to take those things. I'd be asking about palliative care.
Could you point out a reference. I'd be interested. I seem to be ok so far but maybe I just don't know it.
Duane Graveline, MD wrote a book outlining his experiences with statins (ANECDOTE!), but most (observational) studies seem to be inconclusive re cognitive decline. Non-insulin dependent diabetes is a known side effect, but thanks to the SAD, nearly everyone is at risk for that. I'm happy with my cholesterol-rich brain and nervous system, personally, and have no desire to mess with it.
Rogar, what kind of doctor do you go to?
iris lilies
3-22-23, 7:40pm
Rogar, what kind of doctor do you go to?
I would like to know too. He said he goes to a concierge doctor. I go to a direct care physician, same idea.
Mine is an M.D., family practice.
Rogar, what kind of doctor do you go to?
He had been my doctor for many years and is an internist. A couple of years ago he joined what I think is called a concierge organization. He claims his patient load dropped from 1500 to 4 or 500. I'm not rich, but my health is about the best investment I can think of and there are a few advantages to his service. I can get in usually the same day and maybe next. I get the full blood panel from the Cleveland Clinic, a basic hearing screening and eye test, some strength and balance tests, the painful memory test, the usual physical exam, and maybe an hour or more long discussion of the results every year and a midyear light physical. Insurance works differently, but is no better or worse. His marketing says something like, even if you're just not feeling right, give me a call. I don't pay for his office visits and I always see him and not an assistant. I pay $900 every six months.
He's part of a big nation wide network called mdvip and I suspect their basic operations are standardized. Doctors are different and I'd maybe give him a 6 or 7 out of ten, but probably doesn't have much to do with the plan. He's mainstream and has waved me off of unnecessary surgery more than once and got me to a good specialist when I needed it.
When I first signed up I was very healthy and price seemed too much. Since then some things have changed and I think it has been a good investment and provides some peace of mind, too. I'm still pretty healthy, but you never know.
So an internist in a concierge practice. I know IL goes to a concierge practice. There is one here, but I'm already paying so much for Medicare, and if I could find a good primary, I would not need to pay that extra. On the other hand, maybe the one here is worth it. I am thinking I won't try the geriatrician because I don't want someone saying, well you're old, you can't expect to feel better, can you.
I am having a heck of a time getting a good specialist for my orthopedic problems. My husband also has ortho problems, and this week he got an appointment finally but it has been a 5 month wait. He is now scheduled for surgery, but they don't have an opening until October.
The medical system seems to be a maze of decision making. A concierge practice would not be likely to help with specialist issues. My Medicare plan is a supplemental plan through Blue Cross and I don't pay anything for that. Another point in the decision tree and I don't have a strong opinion either way, but it could possibly be a trade to free up some extra for a concierge doctor if it would be a reasonable trade off? It's kind of beyond my scope to say.
The problem here we experience is that you need a primary referral to get to a specialist, even though my Medicare is not set up that way. But they literally will not see you, and if your primary is terrible, then you don't get to see a specialist.
iris lilies
3-23-23, 12:16pm
I will be the first to say I don’t get my “moneys worth” for my direct care physician for which I pay $900 a year. But I don’t care. I go once a year for the exam she requires to continue blood pressure medication, that is standard. I go to her office because it’s close by, easy to get to, and I like her although I’ve not seen the doctor in two years I see her nurse practitioners.
Last year I went a second time for a allergy test that pricked my arm and I paid around $150 for the test kit. That turned out to reveal not much. Yet I clearly have seasonal allergies, pollen allergies, plant allergies. And now food allergies since I got the results back of the food test and it was shocking. Highly allergic to eggs I am.
By “allergic “I mean I’m trying to solve the endless mucus production and coughing that comes upon me. I don’t get an upset stomach or feel sick.
I suspect what I will end up doing is living my life and taking an over the counter allergy medication as I’ve always done.
I only played around with these tests because I was mildly curious, not because I expected them to solve a problem or reveal anything important because I don’t have that much faith in these things.
Teacher Terry
3-23-23, 12:24pm
That’s awful Tybee that you need a referral for specialists. I don’t here but it can be a 6 month wait and my doctor said she can’t get a patient in faster with a specialist then they can do themselves. I pay 400/month for all my health insurance so not paying for a concierge’s services plus I love my doctor.
I will be the first to say I don’t get my “moneys worth”...
I pretty much detailed what I get for the money. I have to say it is a bit of a luxury, but I can afford it and I'm satisfied. I probably could be fairly happy otherwise if I could find a good alternate doctor, but it seems like good doctors can be hard to find. I'm not even overjoyed with mine.
The problem here we experience is that you need a primary referral to get to a specialist, even though my Medicare is not set up that way. But they literally will not see you, and if your primary is terrible, then you don't get to see a specialist.
Same here
Went to my Medicare annual visit and was quite pleased with the family practice doc. Young and open-minded about tests and such. Since there were no obvious issues and I had blood tests a year ago, he said any testing is unnecessary and are up to me which was unexpected. He said that over-testing is rampant. I have some sort of weird no-cost to me hybrid insurance from my work at the university. Blue Cross but structured like an advantage plan. With that and Medicare, I have never had to pay a cent or any deductibles for specialists thus far. It remains a mystery to me how it works.
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