Referrals
Your doctor has looked you over and decided you are someone else’s problem. Congratulations: you have been referred.
The referral names a kind of doctor. It does not say which one, how to reach one, or what it will cost to try. You may be wondering how you are supposed to manage that. We are glad you asked.
Medicine is complicated, and it is sensitive. Because it is complicated, you would not understand it if we explained it, so we don’t. Because it is sensitive, it is private, and so is everything we file under it, the prices included.
Our service is what is wrong. With you, we mean: what is wrong with you is the problem, and the problem is one only the family can solve.
Solving it, we made a second problem: finding your way through all of this. That one is yours. We have never sold a way through it. The longer the way, the more there is to bill. It took the family years to make it this hard.*
Seen here: the referral desk, taking your case.†
†The odds are not posted. The house knows them by heart.
The first spin: your eye hurts, so the wheel lands on the eye doctor, which is where eyes go. The eye doctor looks for a long time and finds a perfectly good eye, with a problem somewhere behind it. No one could have known. Spin again.
The second spin: it was never the eye. It was the blood, and blood, the family decided, belongs to the heart doctor. So that is where the wheel lands: a new waiting room, a new clipboard, a new copay.
The third spin: the heart doctor cannot say whether it is the heart, or the heart and something else. So you will see both. Two doctors, two waiting rooms, two copays: we call that being thorough.
Don’t worry about finding them. Every doctor on the wheel is a friend of the family, and every one has promised, in writing, to send you only to another. The wheel has no other numbers on it.
The wheel stops when you have met your deductible. It starts again in January. Feeling lucky? Take a spin.
The real answer
Do I need a referral to see a specialist?
Your plan’s own rules decide when you need one, within limits the law sets. Most plans that have you name a primary care doctor must let you pick any in-network one who is available to take you, and an in-network pediatrician for your child. And a plan that covers obstetric or gynecologic care cannot require a referral or authorization for a woman to see an in-network OB-GYN (42 U.S.C. § 300gg-19a(a), (c) and (d)).
Seen here: our doctors, deciding where to send you next.