Quote:
Originally Posted by Mudder
I have had quite the opposite experience. Need to see a specialist in Boston for a little known condition. Went to Villages Health Care office in Lake Sumter, a customer service person did all the paperwork right there and then on computer, received letter of approval two days later from United Health Care.
Needed a referral to out of network doctor at U of F Shands, same thing, had the approval letter the very next day!
Of course there was a wait time of about a month for each specialist. The best part, co pay $15 each!
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Which is why I think that either it was not properly done by the PCP in the OP's case, or the reason to go out of network was , well, dubious or possibly premature. No way to tell without knowing what tests and evaluations were done locally. Some doctors don't have the inclination to jump through the hoops to get the referral approved, some other doctors don't take the evaluation as far as they can before sending the patient to a specialist. Insurance companies are good at spotting both these scenarios. What they will never approve is a patient who "wants" to see Dr. X without a clear cut reason.