*I am an employee/doctor that works within a health system that I’m also a patient at, and I have an HMO.
– Last month I injured my neck and had severe radiating pain. I visited urgent care, which misdiagnosed as a muscle strain and didn’t image.
– I visited my PCP a week later and he said I had a ‘muscle strain’ & refused to image, but recommended I return in a month if it isn’t better. I said I had access to an ortho at the health system’s “primary care specialty clinic” and he said I could go see them if I’m not better b/c it’d be quicker. This is the same “primary care specialty clinic” he suggested I use months ago for dermatology.
– I continued to experience severe pain and went to the ortho at this “primary care specialty clinic” 3 weeks later (within the same health system) who imaged/MRI and diagnosed me with a herniated disc in my neck very quickly and referred me to neurosurgery.
I just found out my health insurance (HMO) won’t cover the specialist, imaging or future referral to neurosurgery because it wasn’t ordered by my PCP. The health plan is also NOW telling me I can’t use the “primary care specialty clinic” under my plan, even though my PCP said I could go there without a referral because I’m a doctor at this health system and gave me the contact in the first place!
So I reached out to my PCP, and PCP said he won’t authorize referrals for ortho, neuro or MRI/imaging bc he doesn’t find it medically necessary still.. Even with imaging proving I have a herniated disc to explain my severe pain…. Meaning I’m now on the hook out of pocket for the visits and imaging!
Is there anything I can do? I am so upset with this PCP and his failure to provide accurate diagnosis, treatment, consult or referrals. I don’t know how to proceed at this point.
submitted by /u/throwaway_446666
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*I am an employee/doctor that works within a health system that I’m also a patient at, and I have an HMO. – Last month I injured my neck and had severe radiating pain. I visited urgent care, which misdiagnosed as a muscle strain and didn’t image. – I visited my PCP a week later and he said I had a ‘muscle strain’ & refused to image, but recommended I return in a month if it isn’t better. I said I had access to an ortho at the health system’s “primary care specialty clinic” and he said I could go see them if I’m not better b/c it’d be quicker. This is the same “primary care specialty clinic” he suggested I use months ago for dermatology. – I continued to experience severe pain and went to the ortho at this “primary care specialty clinic” 3 weeks later (within the same health system) who imaged/MRI and diagnosed me with a herniated disc in my neck very quickly and referred me to neurosurgery. I just found out my health insurance (HMO) won’t cover the specialist, imaging or future referral to neurosurgery because it wasn’t ordered by my PCP. The health plan is also NOW telling me I can’t use the “primary care specialty clinic” under my plan, even though my PCP said I could go there without a referral because I’m a doctor at this health system and gave me the contact in the first place! So I reached out to my PCP, and PCP said he won’t authorize referrals for ortho, neuro or MRI/imaging bc he doesn’t find it medically necessary still.. Even with imaging proving I have a herniated disc to explain my severe pain…. Meaning I’m now on the hook out of pocket for the visits and imaging! Is there anything I can do? I am so upset with this PCP and his failure to provide accurate diagnosis, treatment, consult or referrals. I don’t know how to proceed at this point.
submitted by /u/throwaway_446666 [link] [comments]Read Morer/HealthInsurance