[KerryLimber]

I have Keystone which requires a referral from my Primary doctor every time that I go to any specialist. Because of my migraines, I go to a neurologist fairly regularly and am vigilant with making sure that I call my Primary doctor to get a referral and have them fax it over to my Neurologist's office. This past January of 2008 I went as usual for a follow-up and I don't remember the clerk mentioning that they didn't have a referral on file for me for that appointment, which is the usual if they do not have one for a patient. Well, I just got a bill for almost $200 for not having a referral from that appointment. I called my Primary doctor and they have no referral on file for me for that date, even after telling me that they did in fact have one and that they would fax it right over to the neurologist's office. After being put on hold forever, she came back to tell me that she was wrong and that they didn't have one. What I want to know is, can the Primary type one up from that date, and am I being unreasonable to ask them to do this for me? I've been going to them since I was in elementary school (I'm in my thirties now and I now live in PA and they are located in NJ). Doesn't this seem like the fault of the doctor's office, since I know that I keep up with this kind of thing and ordered a referral??
Any advice is greatly appreciated! Thanks!!

[twinkiedooter]

I don't believe it would be legal to "backdate" a referral like you want the doctor's office to do. Unfortunately, that is not going to help your situation financially, but it will ensure that you double and triple check in the future for any referrals that need to be made.

[tootired75]

Hi Kerri,

Your best recourse at this point is to ask the dr's office to waive those charges if they did indeed give out incorrect information. It's funny that having worked in medical insurance for over 10 years I can't recall if a referral can be backdated. And even if the dr would write it up I don't know that the insurance company would honor it. On the other hand you can always get the referral and a statement from the dr office stating it was their error and file an appeal.

I am curious however, in my experience with HMO's or Gatekeeper plans, once you get a referral to a particular specialist it remains active for a specified amount of time so you don't have to get a new referral every time. It seems odd that you have to get a new referral for every visit. The only question is how frequently do you see the neurologist? And if there is a clause that allows the referral to remain active for a specified length of time. If you don't see this specialist frequently its possible that the referral expires. I would check into the referral process with the insurance carrier or with you plan administrator for more information.

-M-