Navigating the medical system- Referrals

[Bunion 2020]

On Medicare. Started with a new PCP this year, been in 1x for checkup/physical.

I have had issues with my right ear and tonsil off and on for the past 10. Tonsil is a bit swollen right now and I want to see an ENT. Called the ENT practice and was told I need a referral. Contacted my PCP for referral and it was suggested I see the PCP 1st.

WTF???

[MagnificentUnicorn]

Advantage plan?


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[skaredshtles]

Standard operating procedure... insurance wants to avoid the expensive ENT visit if it's just a Z-pack for infection.

[Peruvian]

I got a referral for a hip replacement last month. Being a good patient I decided to call around to different surgeons to see who was in network, what kind of procedures they perform, etc. You know - shop around.

Instead I get responses that say, without a referral we can’t answer your questions or schedule an appointment. We certainly don’t know the costs or OOP prices until after the surgery and we submit the bills for approval.

Fuck the US health insurance system. Profiting off health care is disgusting. And that’s coming from a guy that works for a (non-health) insurance company!

[skaredshtles]

Fuck the US health insurance system. Profiting off health care is disgusting. And that’s coming from a guy that works for a (non-health) insurance company!

It's embarrassing is what it is.

[Bunion 2020]

Advantage plan???? Are you fucking kidding me? No, Part B and G Supplemental. My guess is they want to bill for an office visit.

[Cisco Kid]

I needed a referral from my dentist to get to an oral surgeon. I needed a referral from my CPC to get to a vascular surgeon. PCP referral seems SOP in my experience. If I experienced the Catch 22 that the OP did I'd tell the PCP with a smile "Help me out. I've already called a specialist and they said to call you first so........ I guess you're It."

[Bunion 2020]

Not that I give a shit one way or the other as I have already exceed my deductible. But THIS is why medical care costs so fucking much.

[mcski]

Technically, w G you don’t need a referral. It’s basically gate keeping by the office staff. They don’t want to deal w the aftermath of people showing up that needs referrals so they make everyone get one whether they need it or not. I’m not sure you can even process a real referral with a G supplement. Super annoying on all levels and not what your paying for ( ppo vs vs hmo)

[MagnificentUnicorn]

Advantage plan???? Are you fucking kidding me? No, Part B and G Supplemental. My guess is they want to bill for an office visit.

Oh good, I figured you were smarter than that


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[skaredshtles]

Not that I give a shit one way or the other as I have already exceed my deductible. But THIS is why medical care costs so fucking much.

Amongst a myriad of other reasons.

It's fucking embarrassing.

[up an down]

I got a referral easily and quickly for a knee surgeon.. Total knee replacement will happen June 12..hopefully...

[Bunion 2020]

Had to do the office visit for the referral.

So it goes.

[old goat]

There are good reasons for requiring a PCP referral--a lot of times the referral the patient thinks they need they don't or it's the wrong speicalist, the PCP knows the specialist will require treatment or tests by the PCP first, the PCP can treat the problem without a specialist. My PCP has been able to treat several things that I thought I needed a referral for. He has also referred me without a visit to him first. Depends on the situation.

There are also plenty of bad reasons but you don't need me to point them out.

[Bunion 2020]

Thanks, as I said and have confirmed, I have met the deductible so no $$$ from my pocket. And in retrospect, this is a new PCP who has only seen me once prior so wtf? Might as well give her the benefit and see what she has to say. This is for a TMJ and tonsil issue I have been fighting with for + 10 years. She is an Osteopath and may have some good insights.

[old goat]

I've got an internist who does steroid injections, treats precancerous skin lesions, evaluates sore shoulders and prescribes exercises. All the stuff most general internists won't do. Saves me a lot of referrals. The only problem is I can't understand most of what he says because of his Vietnamese accent. (There were 20 Dr. Nguyens in my hospital when I retired, although my doc wasn't one of them. American medicine would be fucked without immigrants. Like construction.)