Referral from PCP?

Hi, I have read some posts / profiles where people needed a referral from their pcp. Is this true in all cases? certain doctors? or certain insurance companies? Thanks for your help

Yes, I got a referral from my PCP for my insurance company Kathy K

I have Aetna PPO and I had to have a referral from my PCP AFTER having met with him for 6 months straight. It's pretty bad.

Amy: My insurance did not require a written letter of referal. My surgeon did however. I think they wanted it because it documented my medical history and the fact that my PCP felt that I was a good candidate for WLS. Hope this helps. Chryssie

Call your insurance carrier and ask if your plan requires a referral. For Health Net, if you have a "CHARTER" plan, this means you never need a referral to see a specialist. All carriers (Health Net, Oxford, Aetna, US Healthcare, etc ..) have different PLANS to choose from, so it is NOT safe to say that if one other person has an Oxford plan and they didn't need a referral than you wouldn't either. So please call. Tara (radio DJ by night, licensed insurance producer by day)

My insurance (connecticare) requires a referral from my pcp to see any specialist. Best thing to do when in doubt is just ring up the insurance company and doctors office and ask

I did not require a referral from my PCP. It was a relatively easy process. Each insurance company is different. Leslie

I have Health Net HMO, and I did not need any referrals at all. Maggie

The question is weather or not you have what is called, 'open access' and therefore don't need a referral. AND weather or not your insurance (and possible your surgeon) will require a letter of recommendation (otherwise known as a letter of medical necessity) from your PCP. I'm guessing that with Oxford you do NOT have open access (it's rare to see an Oxford Open Access Plan) and therefore you will need to get a referral to even see the surgeon in the first place. It's no different than if you had say...ingrown toenails...you'd need a referral from your PCP to go and see the Podiatrist, in order for your insurance to consider covering the service. After you get the referral, you may need a LETTER OF MEDICAL NECESSITY from your PCP to your insurance company. Some insurance companies will accept a letter of medical necessity from only one Dr. some will require letters from both your PCP and your Surgeon. It all depends on the guidelines your health plan has set up. In order to know that, you're going to need to call the insurance company and ask. No matter what the Ins. Co. says, I strongly advise you to get your PCP on board with this. It NEVER hurts to have someone else on your side when you need them. Even if you don't NEED him technically, it's VERY helpful to have another Dr say that you require this surgery. Also, they will be doing a lot of the follow up care with you, so they need to be o board with the proceedure or you're in for a tough time. Good luck to you! Lisa C