How Do Doctor Referrals Work?

[IggyWH]

I did a search on Google and didn't come up with much information on what I'm looking for. I wanted to know if anyone knows anything about doctors referrals?

My situation :

I got a job but I have to pass a physical first. I have a heart condition, so the physician would not pass me but gave my old doc back in Pittsburgh the chance to pass me. They wouldn't, saying that they would have to see me first. So now, I have to see a cardiologist so he can pass me because of my heart condition.

The doctor I saw for the physical in SD can't refer me because "they're not my PCP". My Pittsburgh doctor won't refer me because I don't have their insurance anymore.

What the hell can I do at this point? Can any doctor refer you? I mean, I have relatives who work in the medical field and they might be able to sweet talk a doctor to help me out in my situation, but obviously they won't do anything if it's bad for them (ie unethical).

[kerowo]

You need to either find a primary care provider and have them refer you or get on the phone to your insurance company and have them do it.

[MissT74]

How did you see the doctor for the physical in SD if they're not your PCP? Did you pay cash for the visit?

1. Call your ins co right away and find out who your PCP is, most HMO's will assign you a PCP if you don't special request one.

2. If they have assigned you, call that Dr, make an appt, see if THEY will pass you. If they don't pass you, then they'll send you to the cardiologist.

3. If they haven't assigned you to a PCP, then you need to find one in your area, one referred by parents or friends, etc, or have them refer one to you, get signed up with that Dr. as a PCP and then call for an appt and see #2.

Keep in mind that as a new HMO patient, your PCP is only required to see you within 24 hours for a true emergency, 2-3 days for an urgent visit and up to 30 days for a routine exam.

Over/Under on first available date for new PCP visit: 19 days.

T

Your Health Insurance/Doctor's Office Expert [img]/images/graemlins/wink.gif[/img]

[CappyAA]

Yeah it's a pain in the ass to find a PCP. You either need to go to your insurance company's website or call them to find a list of eligible PCP's in your area. Call down the list and make an appt. with the first one that is willing to take new patients.

I'm not sure if cardiologists work this way at all, but sometimes specialty doctors don't require referrals. You may want to call a few cardiologists in the area and check on that to see if you don't have to waste a bunch of your time. When I hurt my knee earlier this year, most orthopedists around here required referrals from my PCP first. But the one I was recommended to go to, actually didn't require a referral and took me in right away.

[MissT74]

The referral is only neccessary if you have an HMO or other Managed Care Plan. If you have a PPO, or other self insured type plan then you don't need a referral and can simply call a Cardiologist to get in.

From the OP I took it that he had an HMO.

T

[IggyWH]

Sorry, I guess I wasn't clear. I do not have insurance right now. I got hired through a recruiting firm and they paid for my physical (and will pay for my Cardiologist if I ever end up seeing one).

[MissT74]

OH, then that's another story. What's the exact problem? You call a cardiologist and GO....you don't need a "referral" and if the cardiologist says you do, then you call another one....TRUST ME ON THIS: Any doctors office when they hear you are paying cash, will get you in ASAP, it's more money then what insurance pays.

Let us know what happens.

T

[CappyAA]

[ QUOTE ]
Sorry, I guess I wasn't clear. I do not have insurance right now. I got hired through a recruiting firm and they paid for my physical (and will pay for my Cardiologist if I ever end up seeing one).

[/ QUOTE ]

If this is the case, I would call the recruiting firm who hired you and explain the situation to them. They would be better able to help you out with this.

[IggyWH]

[ QUOTE ]
[ QUOTE ]
Sorry, I guess I wasn't clear. I do not have insurance right now. I got hired through a recruiting firm and they paid for my physical (and will pay for my Cardiologist if I ever end up seeing one).

[/ QUOTE ]

If this is the case, I would call the recruiting firm who hired you and explain the situation to them. They would be better able to help you out with this.

[/ QUOTE ]

They're the ones that have me running around in a circle chasing my tail. I'm doing what they're telling me to do, but it's not getting me anywhere.

I think they want me to see a Cardiologist with the place that did my physical and they are requiring a referral. I don't understand why the hell they can't refer me to themselves though when they know this is the only option left for me to pass the physical. I freaking hate doctors.

[MissT74]

Iggy,
You/They/Everyone is making this a LOT harder then it is.

1. The doctor you saw in SD who gave you the test CAN refer you to the cardiologist. They do NOT have to be your "PCP" they can simply give you a verbal referal to go see Dr. So-and-so, the cardiologist.

2. The cardiologist does not NEED a referral as you are cash paying patient, but the cardiologist may WANT a referall from a family doctor so that every Tom, Dick and Harry doesn't just come in for something that a family doctor can take care of.

3. Call the Doctor's office back that you had the physical and speak with someone else, perhaps the girl in the front office or in the "Referral" department just gave you bad information. If they tell you "We can't give you a referral because we're not your PCP" you tell them: "I don't NEED a PCP, I'm paying cash, I just need a RECOMMENDATION on what cardiologist to go see.

The word "referral" and "recommendation" have 2 different meanings in the doctors office. I think the staff is getting these words confused as you are a cash paying patient and any smart cardiologist office will see you right away as soon as they know this.

T