What if you can't get referral to endo?

[toyota1964]

Hi again. Since I am not in the best control yet with my diabetes, I wanted to see an endo. However, my primary doctor won't give me a referral - he says I'm not "bad enough" to see an endo. Any thoughts on this? Thanks in advance for your help!

[Funnygrl]

Find a new primary doctor. Or just tell your primary doctor he's being negligent by not referring you. Sometimes mentioning negligence will get your far.

[notme]

Absolutely find a new doctor. Funny is right! I don't think you need to be "bad enough" to get good information and want a specialists point of view on how to best take care of yourself. Diabetes is a general term for many different aspects of a confusing healthcare issue. Most doctors have a "general" knowledge on how to take care of you. From what I have read on these forums, most of them are as confused as we were when we were first diagnosed.

I would not take no for an answer. If no is the only answer you get then move to an internest at the very least for your primary care.

[HiImDan]

Sounds like you have a terrible doctor-"let's wait til it gets really bad"http://bestsmileys.com/doh/1.gif. I'd do as they've stated and get a new doctor.

[toyota1964]

Thanks for all of your thoughts so quickly! I'll talk to my doc again and if he still says no, I'll move on to an internist. I've only seen this doc since 11/06 - switched from my first doc because he didn't treat my diabetes or my high blood pressure properly.....

[Cyborg]

OMG! Please ditch that primary doctor asap. You posted earlier that you couldn't get your bg down below 400. What does your primary physician need to justify a referral! :motz:

[msdebagain]

oh my! learn from me. i was with a horrible doctor who barely monitored me, and it was SO apparent i was a BAD diabetic. i finally was able to get to a new health care thru my husbands work, and unfortunately it was almost too late. i ended up less than 2 weeks after leaving my doctor getting Diabetic Ketoacidosis and was hospitalized almost dying. the doctor i have now is great, we work together on my health. NEVER again will i leave it up to the doctor alone. its a team effort. Good luck to you!

[cherokee_psh]

From another thread I read you do not need a referral. Call your insurance provider too! Being proactive and having BS in good control saves them money in the long run. They will help you locate a doctor.

[toyota1964]

I found one endo on the insurance company list that would see me without another doctor's referral, so I have an appointment in July. Thanks for all the support and help! It was interesting to me to discover that the insurance company doesn't require a referral from the primary doctor to an endo but all but one of the endos require a referral so they don't steal someone's patient. Of all the reasons......that was a shocker!

[shockme]

glad you're gonna see and endo.take care,trish

[JasonJayhawk]

Make sure your insurance company will still pay without the referral. Some insurance companies won't pay without the primary care physician approving the referral -- you'll end up getting stuck with the full bill at the specialist's contract rate with the insurance company, otherwise. Just depends on your insurance company!

Many PCP's don't refer Type 2's because they feel they have adequate training to deal with the hundreds of Type 2's that they deal with. Ironically, much of their recent training is by the drug companies. (Same goes for endocrinologists, though).

Good luck, and make sure you have your billing covered!

[cherokee_psh]

Make sure your insurance company will still pay without the referral. Some insurance companies won't pay without the primary care physician approving the referral

PPO means the patient is in control, no referral necessary. We pay a little more for this option. HMO means at the mercy of the primary doctor.

[rzrbks]

Get RID of that Dr. and find another.

That being said..............I have been to an Endall once..........such a pompous @##(^%(&^ that I never went again.

I had a Great Primary------that Crud went and joined Drs Without Borders(obviously a sorry human being) and left me in the lurch, but after a year of hunting I found another Great Primary and am happy as a clam

worst A1c ( he brags justa bit) 5.9, once all the rest have been between 5.1 and 5.4.

My CDE and I talked it over at great length and she and I decided that an Endo wasn't the way for me to go.

If you do find a Good One, hang on to her/him and get weller.

[JasonJayhawk]

PPO means the patient is in control, no referral necessary. We pay a little more for this option. HMO means at the mercy of the primary doctor.

I don't think the original poster has a PPO, though I could have missed it.

I was lucky to be on two different HMO's that did not require a primary doctor to dictate the plan. This is actually a new trend in healthcare.

Instead, the HMO and PPO were different in the percentage of costs paid and the number of doctors available. The PPO had more doctors and was an 80/20 payment, whereas the HMO cost a lot more (twice as much per month!), but was $20 copays for primary and specialist visits.

[cherokee_psh]

Instead, the HMO and PPO were different in the percentage of costs paid and the number of doctors available. The PPO had more doctors and was an 80/20 payment, whereas the HMO cost a lot more (twice as much per month!), but was $20 copays for primary and specialist visits.

Interesting....my PPO works the same as the HMO option if I stay in network with regard to doctors and copays eveything is the same. The PPO affords the opportunity to go directly to a specialist without a referral. Yes, the PPO does also have out of network providers for 80/20 coverage (I have not used this option). HMO is the cheaper option. My employer has a HSA (cheapest of all) option too. Designed for those that are in good health and rarely see the doctor. Health Savings Account is just one step above not being insured at all.