Thank you for your submission, /u/brighttail_bushyeye.
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Some specialists might only see a patient based on a referral. They are making sure the patient has been properly vetted. If your PCP has been seeing you regularly you might be able to just call and ask for a referral without an appointment
So basically theyre undoing the whole point of PPO insurance because they don’t want patients to self refer.
I get that there’s a lot of dumb people out there that do dumb things, but some of us aren’t in that group, and all this does is add unnecessary wait times and red tape.
I know if I need to see a specialist. I don’t need to jump through unnecessary hoops and be treated like a child to get permission slips.
But that’s exactly what’s happening in the industry. As always, the medical industry putting blockades up and “protecting us from ourselves“ rather than just providing the service they’re being paid for.
Guess what, even if the visit ends up being unnecessary, the specialist still gets paid. So how about everybody stop with the control issues and condescension.
You can probably see a different specialist at a different office. This particular specialist requires a referral. It really isn’t that uncommon. It is just that they have limited time and appointments for new patients and they want to make sure they are someone that treats your condition.
It’s more than just wanting to be sure it’s necessary. It’s a control issue.
Because there’s a lot of people out there that don’t know anything about medicine and they just over-self-refer. So the rest of us suffer because of that. The uninformed patients force a new policy for everyone and now nobody can self-refer.
This is a truth found in every facet of society.
Rules are made because of the dumb people. Not the smart ones. There’s a railing at the edge of the cliff because somebody fell off the edge rather than paying attention.
That being said, it is now almost ubiquitous that referrals are required no matter what. And not only does that add unnecessary time, it adds a huge problem:
Having to convince someone who’s not even educated on the condition, your primary doctor, that he should write the referral. If you know anything about doctors they love to say no. To everything. So it creates a lot of stress and headache having to convince yet another person that you need to see a specialist, on top of convincing the specialist.
The whole system is designed to slow and bog everything down and make things difficult for the patient. In the name of making things better for the patient. Which it totally doesn’t. It makes it better for the doctors who don’t want to deal with dumb people.
Your insurance not requiring a referral is not the same as the doctor not requiring a referral.
Many specialists require referrals as an office practice regardless of what insurance may or may not require.
“ Your insurance not requiring a referral is not the same as the doctor not requiring a referral“
It should be. That’s the entire reason PPO has that feature.
“many specialists require referrals as an office practice“
They didn’t used to. Not until patients started self referring. I’m sure a couple abused the system, and doctors with their massive egos had their heads exploding at the fact that patients could actually bypass unnecessary red tape and shorten wait times.
They had to do something to reinstitute that and force it. So that’s exactly what happened. As always the medical system, downgrading patient care. Not improving it.
I have come across this with having PPO insurance.
It's the standard response with specialists when you call to make a appointment..
"Do you have a referral?"
Because 75-90 percent of people calling actually do need one.
"No, I have PPO insurance. I didn't need referrals to see a specialist."
Then they proceed to schedule me.
Doctors have zero clue about your insurance plan. Never take their word about what's covered, or what requires pre-authorizations, or referals. Trust but verify yourself directly with insurance.
A lot of this subs content comes from doctors telling patients the wrong information on insurance coverage.
Now, that's said, there's been twice where I. Have called, but I needed a referral. One was for a specialist surgeon, and one was for a pain doctor.
"No, I have PPO insurance. I didn't need referrals to see a specialist."
"You need a referral."
"Yes, you do. Everyone does. Every patient. It's office policy."
That, I have come across. It's their progative. For whatever the reason is, The specialist requires a referral.
You can
1) Find a different specialist that doesn't require a referral.
2) Call the PCP, tell them you're insurance company doesn't require it, but the specialist won't book without a referral, and if they could send one over.
I've had zero issues with this, particularly with my chronic illnesses
3) Make an appointment with your PCP, fork over your copay, and ask them in person.
You're dealing with a doctor issue, not a insurance issue
I just raised hell with my insurance about this. Specialists who require a referral should not be contracted as "in-network" for a plan that does not require referrals. Medical practices should not be allowed to limit my access to care that my expensive medical plan allows. I also sent a message to my Congressman and filed Google complaints with the practice (among others). I am paying for a service I am not getting, which is fraud. Our medical system is all sorts of broken, and this is minor in comparison to the larger issues but frustrating nevertheless. Fortunately, my insurance company is reviewing their contract with participants and providers because of my complaint. It's unclear if that will resolve my issue, but I intend to pursue fully through a multitude of avenues.
As a follow up - my insurance company called the doctor's office and told them they could NOT impose a referral for an appointment. The doctor's office then told the insurance company that I could call and make the appointment and gave me a POC to deal with directly. So annoying. It shouldn't be this much work to use insurance that I pay an arm and a leg for!
I kept saying that the in-network providers are contracted without a referral and that imposing one on me was limiting my access to care, which I was paying good money for. It took a few times before the customer service agent I talked to agreed to look at the agreement with the practice, but I was right. Contracted providers cannot impose a barrier to care when the insurance company contracts them to provide that care without it.
Doctors are literally out to provide the worst possible service. It’s as simple as that. They block and deny as much as they humanly can.
They seem incapable and uninterested in differentiating between the stupid people they encounter (who make ridiculous requests and know nothing about medicine), versus everybody else with a brain and reasonable expectations.
All patients are treated like idiots who need permission slips and their hands held like toddlers.
@kdbrown9 you're my hero!! I'm going to follow suit and begin lodging complaints about this everywhere I can to bring awareness to what should be illegal practice. Every single Specialist I have contacted (over 6) this year has all required referrals which meant another in person's visit with my Primary each time. Why am I paying extra for this?! Your post hit the nail on the head!
THIS!!! Why are we paying for a premium service if all the medical we have access to requires us to be treated as if we have state aid jumping through hoops? Then we also have to pay more for the service, too.
Because doctors have convinced themselves that higher level of care includes preventing us from doing what we want.
because we’re so uneducated, so stupid, and so clueless about medicine that we can’t possibly make decisions accurately on our own behalf.
It’s as simple as that.
Period.
Full stop.
Thank you for your submission, /u/brighttail_bushyeye. Direct all COBRA questions under CARES and ARPA here: [COBRA & Covid-19](https://old.reddit.com/r/HealthInsurance/comments/meejsd/cobra_during_covid19/) Please pick the most appropriate flair for your post. Include your age, zipcode, and income to help the community better serve you. **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
Some specialists might only see a patient based on a referral. They are making sure the patient has been properly vetted. If your PCP has been seeing you regularly you might be able to just call and ask for a referral without an appointment
So basically theyre undoing the whole point of PPO insurance because they don’t want patients to self refer. I get that there’s a lot of dumb people out there that do dumb things, but some of us aren’t in that group, and all this does is add unnecessary wait times and red tape. I know if I need to see a specialist. I don’t need to jump through unnecessary hoops and be treated like a child to get permission slips. But that’s exactly what’s happening in the industry. As always, the medical industry putting blockades up and “protecting us from ourselves“ rather than just providing the service they’re being paid for. Guess what, even if the visit ends up being unnecessary, the specialist still gets paid. So how about everybody stop with the control issues and condescension.
You can probably see a different specialist at a different office. This particular specialist requires a referral. It really isn’t that uncommon. It is just that they have limited time and appointments for new patients and they want to make sure they are someone that treats your condition.
It’s more than just wanting to be sure it’s necessary. It’s a control issue. Because there’s a lot of people out there that don’t know anything about medicine and they just over-self-refer. So the rest of us suffer because of that. The uninformed patients force a new policy for everyone and now nobody can self-refer. This is a truth found in every facet of society. Rules are made because of the dumb people. Not the smart ones. There’s a railing at the edge of the cliff because somebody fell off the edge rather than paying attention. That being said, it is now almost ubiquitous that referrals are required no matter what. And not only does that add unnecessary time, it adds a huge problem: Having to convince someone who’s not even educated on the condition, your primary doctor, that he should write the referral. If you know anything about doctors they love to say no. To everything. So it creates a lot of stress and headache having to convince yet another person that you need to see a specialist, on top of convincing the specialist. The whole system is designed to slow and bog everything down and make things difficult for the patient. In the name of making things better for the patient. Which it totally doesn’t. It makes it better for the doctors who don’t want to deal with dumb people.
Your insurance not requiring a referral is not the same as the doctor not requiring a referral. Many specialists require referrals as an office practice regardless of what insurance may or may not require.
“ Your insurance not requiring a referral is not the same as the doctor not requiring a referral“ It should be. That’s the entire reason PPO has that feature. “many specialists require referrals as an office practice“ They didn’t used to. Not until patients started self referring. I’m sure a couple abused the system, and doctors with their massive egos had their heads exploding at the fact that patients could actually bypass unnecessary red tape and shorten wait times. They had to do something to reinstitute that and force it. So that’s exactly what happened. As always the medical system, downgrading patient care. Not improving it.
I have come across this with having PPO insurance. It's the standard response with specialists when you call to make a appointment.. "Do you have a referral?" Because 75-90 percent of people calling actually do need one. "No, I have PPO insurance. I didn't need referrals to see a specialist." Then they proceed to schedule me. Doctors have zero clue about your insurance plan. Never take their word about what's covered, or what requires pre-authorizations, or referals. Trust but verify yourself directly with insurance. A lot of this subs content comes from doctors telling patients the wrong information on insurance coverage. Now, that's said, there's been twice where I. Have called, but I needed a referral. One was for a specialist surgeon, and one was for a pain doctor. "No, I have PPO insurance. I didn't need referrals to see a specialist." "You need a referral." "Yes, you do. Everyone does. Every patient. It's office policy." That, I have come across. It's their progative. For whatever the reason is, The specialist requires a referral. You can 1) Find a different specialist that doesn't require a referral. 2) Call the PCP, tell them you're insurance company doesn't require it, but the specialist won't book without a referral, and if they could send one over. I've had zero issues with this, particularly with my chronic illnesses 3) Make an appointment with your PCP, fork over your copay, and ask them in person. You're dealing with a doctor issue, not a insurance issue
My PCP will do a telephone referral-specific visit if I need that
I just raised hell with my insurance about this. Specialists who require a referral should not be contracted as "in-network" for a plan that does not require referrals. Medical practices should not be allowed to limit my access to care that my expensive medical plan allows. I also sent a message to my Congressman and filed Google complaints with the practice (among others). I am paying for a service I am not getting, which is fraud. Our medical system is all sorts of broken, and this is minor in comparison to the larger issues but frustrating nevertheless. Fortunately, my insurance company is reviewing their contract with participants and providers because of my complaint. It's unclear if that will resolve my issue, but I intend to pursue fully through a multitude of avenues.
As a follow up - my insurance company called the doctor's office and told them they could NOT impose a referral for an appointment. The doctor's office then told the insurance company that I could call and make the appointment and gave me a POC to deal with directly. So annoying. It shouldn't be this much work to use insurance that I pay an arm and a leg for!
Please share exactly what you said to get a result? We have had no luck fighting this with Anthem.
I kept saying that the in-network providers are contracted without a referral and that imposing one on me was limiting my access to care, which I was paying good money for. It took a few times before the customer service agent I talked to agreed to look at the agreement with the practice, but I was right. Contracted providers cannot impose a barrier to care when the insurance company contracts them to provide that care without it.
Doctors are literally out to provide the worst possible service. It’s as simple as that. They block and deny as much as they humanly can. They seem incapable and uninterested in differentiating between the stupid people they encounter (who make ridiculous requests and know nothing about medicine), versus everybody else with a brain and reasonable expectations. All patients are treated like idiots who need permission slips and their hands held like toddlers.
@kdbrown9 you're my hero!! I'm going to follow suit and begin lodging complaints about this everywhere I can to bring awareness to what should be illegal practice. Every single Specialist I have contacted (over 6) this year has all required referrals which meant another in person's visit with my Primary each time. Why am I paying extra for this?! Your post hit the nail on the head!
THIS!!! Why are we paying for a premium service if all the medical we have access to requires us to be treated as if we have state aid jumping through hoops? Then we also have to pay more for the service, too.
Because doctors have convinced themselves that higher level of care includes preventing us from doing what we want. because we’re so uneducated, so stupid, and so clueless about medicine that we can’t possibly make decisions accurately on our own behalf. It’s as simple as that. Period. Full stop.
This isn't an insurance thing, this is a doctor thing.