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slightly OT - insurance referrals?

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Ulcerative Colitis
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Posted 4/2/2014 8:12 PM (GMT 0)
Hi guys, slightly OT question but I know you will know the answer. As many of you know I'm going back to school and I'm considering a health insurance plan that requires a referral to see a specialist, which I've never had to deal with before (anecdotally everyone says it's a huge hassle... but it's also a HUGE savings).

Does that mean that every time I have an appointment with my GI, I would need to have an appointment with my PCP first to get a referral? Or would I just need one referral (e.g. saying that I have IBD) and then I can see the GI as needed?
Posted 4/2/2014 8:16 PM (GMT 0)
Usually a referral covers a certain period of time and a certain number of visits. Your PCP may or may not require you to visit him every time. If you have a cool one who understands your chronic condition you should just be able to call and ask the referral girl to fax one over to the GI's office for you. That's what I used to do. They usually want you to give them anywhere from 2-5 days on the notice for a referral. It's a pain, but not the end of the world.
Posted 4/2/2014 8:50 PM (GMT 0)
Ask the person in your PCPs office that does the refers about the company you are thinking of using and what they do about referals. If the PCP forces you to visit and some try to pull that, might want to pass on it. My mom had that problem and demanded they handle it on the telephone and they did. Some PCPs do not want visits for referrals because it is a waste of time. It might not be a big deal at all.
Posted 4/2/2014 9:51 PM (GMT 0)
Usually one referral in the beginning.
Posted 4/2/2014 10:17 PM (GMT 0)
Really it depends on the relationship you have with your PCP- I've been with mine for going on 13 years, so he gives me referrals to anyone, anytime! With my GI, since I've been seeing him forever also, my PCP usually gives me anywhere from 3-6 visits at a time. Then the specialist will usually tell you when your on your last one, or if you need more referrals. They're easy to get- I just call the referral number at my PCP's office, & give them all the info. And whenever my GI refers me out, I also need another referral from my PCP- to my hematologist, my surgeon. Which he always does too. It's usually not a problem AT ALL, & well worth the savings! Just an insurance red tape, hoop to jump thru, etc. Everything has got to originate from your PCP. For my upcoming surgery, they had to get prior approval for inpatient stay, which my PCP also had to approve.
Posted 4/3/2014 2:48 AM (GMT 0)
when I was in grad school, I had to get one referral each plan year because the student insurance was in essence a new plan each year. Just the way they did it. But this was a group plan for grad assistants that the department pays part of premium. If it was an individual plan and not rewritten each year, you might not need new referral each year.
Posted 4/3/2014 3:12 AM (GMT 0)
Liz,

Another thing to consider is if you are going to School out of state and going "home" for the Summer or traveling. An HMO may not cover you unless it is an emergency room visit while you are out of state and out of network.

Getting a referral for UC/GI stuff shouldn't be difficult since you all ready dx'd but for anything else it would probably require an office visit first.

Also check out the network and see if you like the specialists in Network.
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