Can the doctor refuse to give my daughter a referral of her choice?
She has to have gall bladder surgery. She was originally set up with a Doctor B to do the surgery at South Central Regional Medical Center, which is a local hospital. However, this county is notorious for killing people. The most recent example, a friend of hers, in her late 20’s, otherwise healthy, died about a month ago from septic shock after surgery here. She found out that Doctor B was the one who performed the surgery. (Again, this is not a rare occurrence.)
My daughter called her regular Dr., Dr. J to ask for a referral to Wichita. Apparently the customer service rep told her that Dr. J had already given her referral options.
Corrie said, “Yes, he gave me the choice of Dr. Sam, who I don’t like, and Dr. B, who I just found out did surgery on a friend of mine who died, so I want a referral to Wichita.”
She’s waiting to hear back. Can they deny her the referral because she wasn’t satisified with either of her options locally?
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I would think a doctor or his nurse would help her, otherwise I’d find a new doc.
Is she sure she needs a referral?
Of course the doctor could refuse what they consider a frivolous referral (not saying it is).
Frak referrals.
Find a doctor with a good record, and call them yourself. Almost no insurance company requires a referral anymore.
@Seek_Kolinahr A lot of insurance companies are making referrals mandatory to coverage this year actually. I had to have a dr referral even for my first mammogram and he said it just started happening.
Yes, @Cupcake. You’d have to be insane to have any procedure more serious than stitches done here. This place F’s up all the time. Every time. Almost killed me. My husband got into a motorcycle wreck, snapped his collar bone in half. Went to our local hospital. They just put him in a splint thing that pulls his collar bone back. We found out later that they SHOULD have recommended surgery, to pin the bones back together. People around here die like flies. She needs a referral.
@Seek_Kolinahr I’ll sure keep that in mind. I think the problem is, she’d have to go to Wichita to get re-diagnosed, then make another trip for the surgery, whereas if her existing Dr. could just call and say, “Yeah, she needs the surgery,” that would help immensely.
@Dutchess_III My question was based on her insurance regulations, not the quality of care in your geographic area.
She can just research surgeons herself. She doesn’t need a referral does she?
It’s not a doctor issue. It’s an insurance issue. Take it up with the insurance carrier.
@Dutchess_III I dunno… I’ve never even seen my GP. I went to the hospital in pain, they did an abdominal ultrasound. I took that to a surgeon and said “See this? Take it out”. He said “Ok, how’s Friday?” That was about it.
Found out that yes, she has to have a referral.
I think this is a little different @Seek. It’s not an emergency. I went to the ER, in the middle of the night, with severe abdominal pains. Ectopic (sp) pregnancy, it turns out. Required emergency surgery. Of course, no referral was required.
I’ll let her know @Rarebear. Thanks.
Contact the insurance company and find out who the surgeons in Wichita are. Should be able to go insurance company website and do the research.
Cool. Thanks.
Why do they make it so damn hard?
Because some people try and get facial plastic surgery covered for eyebrow changes without a PCP referral. Other thing is to magically have her in Wichita when she has “acute attack”.
;>)
Go to Witichita for an extra-cheese NY style pizza. That’s what brought on my (last) attack. ^_^
@Seek_Kolinahr Figured it out ! ! Fried chicken and french fries might work too.
LOLL!! Trying to figure out a way to put my daughter on the brink of death, are we?!
Hey, if you want an emergency surgery, I know how to get one.
I agree insurance issue. Does she have an HMO? I avoid those big time, I don’t want to rely on a doctor doing a referral for my insurance. I have stories, I won’t bother you with the long stories, but the short story is sometimes the PCP office isn’t on top of getting the paperwork done, and sometimes the specialist’s office isn’t competent and loses the referral.
Once in a while it is a matter of a specialist requiring a referral, and not the insurance. For instance some oncologists you can’t just make an appointment, because you are worried about cancer, your doctor needs to send the documentation and why they are doing the referral. But, in your daughter’s case it sounds like an insurance issue.
Is the hospital and doctor you want covered under her insurance?
Cheese sauce might work.
Well, she has state insurance.
(I think the cheese sauce DID work. My tummy hurts, Mommy.)
Do all the dcotor’s take the state insurance?
IDK. She hasn’t had any problem so far.
The only time I ran into problems with state insurance (I had it for a couple of years before they cancelled the program for adults) was with dentists. Thank God I had it when I had my emergency surgery. I might have waited to go in until it was too late, thinking about the bill I would have owed out of pocket.
Yes, it helps the states bottom line to deny the parents of the “poor” children health insurance. I mean, no big deal if the parent dies, right?
I think that she is legally entitled to a second opinion but that might be a state thing. (you might want to use the second opinion option instead of bringing up the dr’s incompetence, or in addition to that.)
Meanwhile, how horrific that people are dying in that hospital and that the doctor seems to have some bad statistics also.
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