What to do when PCP won't refer to specialist/expert you want...

[cdklyn]

Our PCP has made a referral to an ped. neurologist that he can't confirm has extensive experience treating PANDAS patients. We've decided to move forward and schedule an appt with what we consider an expert in the disorder, Dr. Murphy in Florida. We have the appointment with her for the end of this month, but still have no referral to her from PCP and not sure we will get one. Anyone that has BCBSTX insurance coverage have a similar situation? Or if you have other insurance, any advice on how to handle??

[thenmama]

My first thought is to find out if a neuropsych visit would count as a psych specialist/mental health benefit-- if it does you may not need a referral.

[Mayzoo]

My kiddo has the BCBSTX Blue choice PPO and a referral is not needed--so it depends a lot on what kind of BCBSTX you have. For me, an office visit within network is an office visit. So long as the doc is on the preffered provider list, we get in network office visit co-pays (up to six a year). This year we will go way over the six for the first time.

Edited March 2, 2012 by Mayzoo