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Old 09-06-2011, 12:02 PM
 
Location: Connecticut
2,727 posts, read 5,508,162 times
Reputation: 1980

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Are you required to see someone from the group your doctor refers you to, or can you go off on your own?

Hopefully I can clarify this and not confuse anyone.

I know certain practices work with certain other practices. If my doctor tells me to see a nutritionist/therapist/fertility doctor/whoever, and gives me the name of someone from XYZ group, am I required to go there? Or can I look for one from another group?

My doctor referred me somewhere and I have to pay out of pocket 100%. Obviously I want someone good, but I also know that certain costs are more expensive in certain parts of the state/country. If I can find someone just as good in another part of the state (which I can), why not go to them right?
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Old 09-06-2011, 03:23 PM
 
Location: Mostly in my head
19,865 posts, read 57,982,807 times
Reputation: 19187
Only requirement would be if you are in a HMO that requires pre-auth and referral. Otherwise, go where you want.
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Old 09-06-2011, 04:04 PM
Status: "Jungian kind of" (set 1 day ago)
 
Location: Hawaii
1,691 posts, read 3,878,548 times
Reputation: 3082
If the doc was giving an actual referral, written up for insurance reimbursement purposes then yes ... if the insurance isn't covering it and doesn't require a referral from the pcp then go to who ever you want. Another thing is the specialist may require a referral as well but if not ...
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Old 09-06-2011, 04:14 PM
 
Location: Victoria TX
42,662 posts, read 76,448,315 times
Reputation: 36233
Good question. I would ask my doctor's office to give me a Rx referring me to a specialist, that I could take to anyone. If he refused, I would smell a rat and ask why not, and he better have a good answer, unrelated to his aspiration of amassing a fortune.

In my case, my doctor referred me for physical therapy, and just wrote it out as a Rx slip, and I went to the one closest to home, that I could walk to, since I had to go three days a week.

On the other hand, specialists can be notoriously hard to see quickly, and some GPs might have a special arrangement with some specialists that they agree to prioritize referred patients. Recently, I was referred (by the ER) to Dr X who was in a practice with Dr Y and Dr Z. When I phoned, they said Dr X was booked for more than a month, but I could see Dr Y on Friday. The receptionist at the XYZ Clinic had never heard of me, but when I told her I had a written referral, she agreed to schedule me, and never asked for verification of the referral, then or ever.
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Old 09-06-2011, 06:55 PM
 
Location: not new to houston anymore
276 posts, read 758,222 times
Reputation: 252
if your insurance won't cover it, chances are that your Dr has no idea and wouldn't mind you seeing someone else. You might want to check if the Dr has another preference that might be in your network--although they may not know who is covered (getting a few recommendations that you can cross check with your insurance is a good idea). Sometimes Drs refer to specific ppl because they think they're good, they have a good line of communication with them (ie the consultant might send them a summary of the visit), etc. In general, they are not going to want to you go out of your insurance coverage area--unless the specialist they're using is very specialized.
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Old 09-07-2011, 08:35 AM
 
Location: Connecticut
2,727 posts, read 5,508,162 times
Reputation: 1980
Thanks you for the responses. Neither my doctor nor I knew if it would be covered, and turns out it is NOT (by insurance). So no matter where I go, I would have to pay 100% out of pocket.

"Sometimes Drs refer to specific ppl because they think they're good, they have a good line of communication with them (ie the consultant might send them a summary of the visit), etc." - very good point new2houston

"might have a special arrangement with some specialists that they agree to prioritize referred patients." - jtur88, and this could very be very true in this case also

Since my doctor and I both had no idea if it was covered or not, when I see her at the end of month, I will discuss it further.
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Old 09-07-2011, 09:23 AM
 
Location: In a house
13,253 posts, read 37,888,439 times
Reputation: 20198
Quote:
Originally Posted by CTGirlNoMore View Post
Thanks you for the responses. Neither my doctor nor I knew if it would be covered, and turns out it is NOT (by insurance). So no matter where I go, I would have to pay 100% out of pocket.

"Sometimes Drs refer to specific ppl because they think they're good, they have a good line of communication with them (ie the consultant might send them a summary of the visit), etc." - very good point new2houston

"might have a special arrangement with some specialists that they agree to prioritize referred patients." - jtur88, and this could very be very true in this case also

Since my doctor and I both had no idea if it was covered or not, when I see her at the end of month, I will discuss it further.
If you wait til the end of the month, your doctor might be expecting that you already went to the specialist she referred you to, or at least made an appointment. If you wait, then it will have been one month passed, with absolutely no action taken on your part.

You should call her office immediately with a message, at the absolute least, informing her that you won't be making an appointment with that specialist.

On the other hand, if none of your insurance covers it, and she feels you really need to see the specialist, it shouldn't matter whether or not your insurance covers it. You should call the specialist and see if they have payment plans.
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Old 09-07-2011, 09:27 AM
 
Location: Connecticut
2,727 posts, read 5,508,162 times
Reputation: 1980
Actually, this isn't a necessity thing. And whther I call doctors now, or wait another month won't matter. It's such an expensive thing that I can't do anything until I have all of the money, which take a while to come up with.
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Old 09-07-2011, 09:28 AM
 
Location: Connecticut
2,727 posts, read 5,508,162 times
Reputation: 1980
Oh, I forgot to add I already saw the specialist, just to clarify some things. I wasn't sure insurance wouldn't cover the procedure, but I wanted to talk to the specialist and get the cost of it.

Last edited by CTGirlNoMore; 09-07-2011 at 09:28 AM.. Reason: spelling
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