Referrals & PCP's

I prefer not to mention commercial insurance carriers by name, so it's going to make today's post a challenge.  Many insurance carriers require you to "declare" a primary care physician (PCP) and any time you need to be seen by a specialist you have to have your PCP refer you to the specialist.  That sounds simple enough, but it can get complicated really fast if you don't know your policy well, because as with any set of rules, there's always an exception to them.  Just because you have insurance coverage doesn't mean you can see any doctor you want either...well you can, but it will all go to your out of network benefits, and depending on what those are one trip to the doctor can become very costly. Another problem we run into is situations where a patient didn't realize that their insurance carrier required them to declare a PCP and then when they needed to see a specialist a referral couldn't be done.  



This picture has absolutely nothing to do with today's topic, it just made me laugh...

Questions? Comments?
deargabbyinsurance@yahoo.com