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  1. #21

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    I work at an insurance company and have been in the industry since the early 80s.

    The requirement for a referral waxes and wanes. Right now, insurers are pressuring primary care physicians to set up their practices so that they are ready to become "medical homes" so that they can receive higher reimbursement under Federal Health Care Reform. Also, many insurers and specialists have issues with self-referrals as there is a segment of the population that insists on seeing a neurologist for every headache, and an orthopedist for every joint ache.

    I would recommend calling the insurance company and asking if the primary care copay can be waived if the sole purpose of the visit is to obtain a referral. Then, ask what their policy is about the 2nd and subsequent visit to the same specialist. Do they keep the referral open for the duration of your problem, or for a specific length of time?

    Also, to avoid having to pay for a second visit, anytime your doctor recommends a specialist, DO NOT LEAVE THE OFFICE, until the doctor has entered the referral in the system!!! Having the right paperwork with the right dates is key.

    Getting familiar with your policy is the best way to get what you need when you need it.
    AceOn6, the golf loving skating fan

  2. #22
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    Quote Originally Posted by milanessa View Post
    Was there a charge for giving a patient a written prescription? I gotta say I've never heard of such before.
    No, just called into the pharmacy. I know this because the NP I saw sat down in front of me and immediately started writing out prescriptions. When I told her that it was okay, I still had refills from my primary provider, she shook them in my face and said "Well, take them anyway!!" (I didn't get billed for that, and I'm not going back there.)

    It's getting to be a pain to find a decent ob-gyn in this area that takes my insurance... another one I looked at has horrible ratings everywhere online. Why? Because apparently she reuses the disposable speculums. As in, rinses them and chucks them right back into the drawer, right in front of the patient. If it was just one person who claimed this amongst other good reviews I'd be inclined to think they were making it up, but when multiple people are saying it,

  3. #23
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    Quote Originally Posted by mkats View Post
    It's getting to be a pain to find a decent ob-gyn in this area that takes my insurance... another one I looked at has horrible ratings everywhere online. Why? Because apparently she reuses the disposable speculums. As in, rinses them and chucks them right back into the drawer, right in front of the patient. If it was just one person who claimed this amongst other good reviews I'd be inclined to think they were making it up, but when multiple people are saying it,
    That should be reported.
    3539 and counting.

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  4. #24
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    Quote Originally Posted by Aceon6 View Post
    there is a segment of the population that insists on seeing a neurologist for every headache
    In my case it wasn't a frivolous visit. The neurologist told me he wanted me in for a follow-up when I was still in the ER.

  5. #25
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    Quote Originally Posted by Karina1974 View Post
    In my case it wasn't a frivolous visit. The neurologist told me he wanted me in for a follow-up when I was still in the ER.
    What a random comment. You have a stroke you see a neurologist. No one accused you of anything.
    3539 and counting.

    Slightly Wounding Banana list cont: MacMadame.

  6. #26

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    In our office, if your condition is chronic and you need to be several times in one week, you can sign a hardship agreement and we will only collect the copayment 1 time for the week.
    "awwww....shades of Janet Lynn" - Dick Button on anyone who makes more than one mistake in their program.

  7. #27

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    Quote Originally Posted by Karina1974 View Post
    In my case it wasn't a frivolous visit. The neurologist told me he wanted me in for a follow-up when I was still in the ER.
    I think your situation was a bit different than the "segment" I describe. You were diagnosed in the ER.

    The people that my ins co has trouble with are the people who never see their PCP and go directly to a specialist for any concern. The first thing a specialist will want is records from the PCP... what was the complaint, what tests have already been done, what is the follow up plan? Going directly to the specialist can actually slow down care in some cases.

    Our insurance recently changed so that we need first time referrals for all specialties except dermatology, ophthalmology and audiology. If someone sees a skin change or has a change in vision or hearing, the PCP is unlikely to offer any advice other than to see someone else, so that policy saves time and money. For everything else, the PCP sets up the referrals and recommends a duration. For example, the Allergy referrals are usually for one season or one year, depending on the allergy. So far, the system works pretty well.
    AceOn6, the golf loving skating fan

  8. #28
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    My insurance doesn't require a referral, although I recently went through them to get an appt with a dermatologist since the PCP's office could get me an appt with a doctor in their practice faster than I could get an appt if I just called directly.
    "The Devil is joining in, and that's never a good sign." Phil Liggett

  9. #29
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    My doctor belongs to a medical group. If I need to see a specialist in that group, I need a referral from her even though my insurance doesn't require it. However, if I decide to see a specialist outside the medical group, I just call them and make an appointment. So far, I haven't self-referred myself to any specialist who required a referral from my PCP but the ones I see outside my medical group are things like my Sports Medicine Doctor.
    Actual bumper sticker series: Jesus is my co-pilot. Satan is my financial advisor. Budha is my therapist. L. Ron Hubbard owes me $50.

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