Quote:
Originally Posted by Ham88
. . . all I need is a referral from my primary care physician and insurance will pay for it, though I'm not sure if they will pay if the referred to doctor is out of network . . .
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At least in my plan, referrals have to be approved by the insurance carrier and they have to be to in-plan doctors unless you can demonstrate that no in-plan doctor has the expertise/knowledge to deal with your problem. Then, if the insurance company agrees, you can go out-of-plan but have to pay the difference between what the insurance carrier would pay an in-plan doctor and what the out-of-plan doctor charges.
Even for tests, the insurance carrier has to preapprove (some don't require preapproval, they are on the preapproved list already). I have had the insurance carrier deny coverage for a test because some doctor or nurse that I have never met or spoken to in the insurance company's office decided I didn't need the test. One can appeal the decision, but that is a nightmare in itself.
Similarly, prescription coverage is up to the insurance company. My doctor can prescribe medication but if it is not on the preapproved list, it isn't covered by the insurance.
So I don't see how the insurance company bureaucracy is any different from any other bureaucracy that might come about from national health care.