New referrals needed every 6 months?

[4horses]

Is this typical? The doctors office told me that referrals to specialists are only good for 6 months after which I need a new referral? Because of insurance.

I’m looking at a 2-3 week delay in treatment every time I have to go back to primary and then wait for them to process the new referral and then wait 2-3 months to see a specialist. It’s getting absurd. And insurance wonders why so many people go to the ER or urgent care for treatment…

I thought referrals were typically good for 1 year. Or maybe I need a new primary care doctor?

They also told me that anytime I need a new referral I have to go in for an appointment. Even if it’s something I already discussed with them multiple times… I’m trying to find a motility specialist for GI issues.

I had the referral but then when I called to set an appointment, the office no longer has a motility specialist on staff (website says otherwise). Anyhow, I did see the nurse but she’s not a doctor and while she attempted to be helpful, I need to see a motility specialist. So back to primary for a new referral…

The amount of time wasted getting a referral is really aggravating.

[Simkie]

It sounds like this is driven by your insurance plan itself. Plans vary widely on pretty much every detail. (Like I don’t need a referral at all.)

That back office type stuff is hard for a lot of primary care clinics. If they’re taking weeks to process a referral, I’d certainly consider going somewhere else.

[4horses]

I know my plan requires a referral but I didn’t realize it would be that often. I’m going to try and find the policy in their packet. I’m hoping they are mistaken. If nothing else, it may be time to switch plans.

[Alterwho]

I need a referral every 6 months but my specialty provider sends in the request to my primary ahead of time and my primary just okays it without having to see me. I’ve been going to the same primary for a decade so it’s not a problem.

My specialist also book out my appts for the next year so I don’t have to worry about not getting in

[Obsidian_Fire]

I would be calling my insurance company and having them spell it out for me, not relying on what the drs office is telling you. They deal with so many companies I am not sure they can keep an accurate track.
This is a case where you’re going to have to drive the ball hard, and be very proactive, even tho you shouldn’t have to.
Also, at least with myself, once I’m referred to a specialist, so long as I’m under that drs care for a continuing issue, I don’t need a new referral.
As for going in every time you need a new referral, that depends a lot on if it is the same diagnosis, or a new one, how long you’ve been a patient at said clinic, and what the specialists office requires. Some of them won’t take a patient unless that patient has been seen (and worked up) by the primary dr; my ortho’s office told me this is because they were getting too many patients who didn’t really need a specialist, causing delays in appointments/treatment for those who truly need the specialist.

Don’t know what area you are in but is there a university hospital/clinic nearby? They might have the type of doctor you are looking for?

[4horses]

It was the university that doesn’t have the specialist I need. They had a fantastic doctor but she stopped working there a few years ago and moved out of state.

[enjoytheride]

I would call your insurance company. With the company I work for, no referrals are required to see a specialist, but providers simply do not believe that. There are many different types of plans, and providers do not know them and often make assumptions that can cost someone a lot of extra money.

[4horses]

I checked my insurance packet and it says every 6 months. I didn’t realize that. How aggravating.

[beau159]

@4horses

Is this typical? The doctors office told me that referrals to specialists are only good for 6 months after which I need a new referral? Because of insurance.

I’m looking at a 2-3 week delay in treatment every time I have to go back to primary and then wait for them to process the new referral and then wait 2-3 months to see a specialist. It’s getting absurd. And insurance wonders why so many people go to the ER or urgent care for treatment…

I thought referrals were typically good for 1 year. Or maybe I need a new primary care doctor?

They also told me that anytime I need a new referral I have to go in for an appointment. Even if it’s something I already discussed with them multiple times… I’m trying to find a motility specialist for GI issues.

I had the referral but then when I called to set an appointment, the office no longer has a motility specialist on staff (website says otherwise). Anyhow, I did see the nurse but she’s not a doctor and while she attempted to be helpful, I need to see a motility specialist. So back to primary for a new referral…

The amount of time wasted getting a referral is really aggravating.

Now just keep in mind that it might not be your PCP (primary care provider) that is holding you up for 2-3 weeks. Likely sounds like a Prior Authorization process to get you referred to a specialist and it is likely the INSURANCE COMPANY that is taking 2 to 3 weeks to decide if you are “approved” to see the specialist.

I only work in a very small segment of the medical world (eyes) and the amount of times I have to fight for a patient with the insurance company is just ridiculous. The time and money wasted. Our system is broken and frustrating, for sure, patients and providers alike. The general public doesn’t even realize the half of it!

[Bogey2]

My referrals were given by the numbers. For instance I would get 4 visits to the specialist and reapply for more before the last one happens. It’s based on the insurer.

[Equibrit]

Referrals can be made a lot easier if the Primary care doctor is associated with a health care system that uses an app like Mychart. My Dr typed a referral into the computer during my appointment. Few days later surgeon’s office called and made an appointment. The following week - job done.