Maybe I can help with a couple of clarifying comments.
A family doctor (who could be a general practitioner, or of the specialty of internal medicine or family medicine doctor, or - for children - a pediatrician) generally is agreed upon by all to be the most effective healthcare provider for routine primary care. An earache is routine primary care. A draining and bleeding ear from a kid sticking a pointed object in his ear canal is maybe not routine and then an ENT is advisable. NHRA is right about the costs; it is under $100 versus over $250 in the KC area for primary care versus specialists. A family doctor (especially in the new patient centered medical home model) is going to organize your meds, your shots, your other illnesses, etc. A specialist is going to deal with just the one thing in front of him that is in scope for his specialty and at most, tell you to go somewhere else for the other conditions. A primary care doctor is going to try to work with you until and unless it is totally out of his scope and experience, and then he should coordinate with the other physicians he advises you to see. Some are better than others about this, I agree.
Oral surgeons are generally not covered under medical insurance policies except for trauma or birth defects. For run of the mill wisdom teeth extractions or root canals, the insurance they will file for you is your dental insurance, not your medical insurance. Some of the citizens of the US do not have dental insuranace, surprise, surprise. These guys are not as much affected by the Obamacare law, therefore. They get their money up front because if they don't, they have to spend money on collecting their fees and the collection agencies take a huge chunk of the money.
Not all insurances work the same way. A primary, as you said, may not be a general practitioner, however, some, not all,
insurance companies require that one is refered to a specialist by whoever it is that one identifies as their primary. BC/BS does not work this way, but others do
. I rarely ever go to the doctor, so I am not an expert. But, I have noticed that doctors are not always available the same day or even within the week. I am a full believer in specialized instrumentation as well as getting out of pain as soon as possible. There is a risk in delaying care and doubling bills by going to a primary first and not an ENT, if one has seriouse earache - or other "ear symptom"..... which was only
given as an example.
Many, not all
, medical insurance plans cover some percentage of almost all the procedures one might go to an oral surgeon for as well as many one would go to the dentist for. Most oral surgeons and dentist
will file first with your medical and then with your dental insurance. I can assure you this is not an "opinion", it is a fact.
It is obviouse why oral surgeons collect up front. My point was not that they collect up front in an effort to eliminate unnecessary visits, but rather that as a result of this practice, "unnecessary" visits are all but eliminated. Perhaps you have never met, known, or heard of anyone that went to the doctor if they stubbed their left toe or got a sniffle...I have. However, as I pointed out..doctors would never want
to collect up front b/cit would reduce the number of "unnecessary visits" which dr's are, YeS... paid for by insurance....which was the point.