Yesterday, when I was dealing with the insurance company over some unpaid bills, it was brought to my attention that my baby's cardiologist needed a referral from my PCP. This referral couldn't come from my OB, even though that is who I was referred by. Even though my PCP has absolutely no charge over my pregnancy, or the baby, the referral had to come from them, according to the insurance company. You see, a referral happens because one doctor is not specialized in a certain field. Therefore, they "refer" you to someone else, who can accomplish what you need. It's not a new concept. It's very well understood in the medical and insurance arena.
So yesterday I called my PCP, whom I have only seen once for a sinus infection, and told them all about my referral needs. I had the fax number, name, Doctor's office, dates...pretty much everything they needed to send a referral. I knew that this sort of thing could be done over the phone. I have worked in Doctor's offices before. I was a great Insurance Coordinator. I'm not ignorant when it comes to the workings of a Doctor's office. This is something that can easily be done over the phone. So I called.
Stupid Receptionist: We have to have you seen by the Doctor.
Brilliant Former Insurance Biller (Me): I don't need an examination. Besides, it's not a referral for me, it's a referral for my unborn baby, whom you can't examine anyway because you are not classified as an OB office. I just need a referral sent over to my baby's Cardiologist so the insurance will allow it.
Stupid Receptionist: But we NEVER do referrals unless we know what's going on with the patient. You'll have to come in.
Me: Well, you can't examine the patient because the patient is a fetus.
Stupid Receptionist: We simply CANNOT do it over the phone.
I made an appointment for this morning, to show up in person, to tell the doctor, in person, how a referral works.
Nice Male Nurse: Shaina? Let's have you come back. Now if you can just step on the scale, we'll get you started.
Me: I'm not here to be examined. I just need to get a referral.
Nice Male Nurse who obviously knows when NOT to mess with a pregnant lady: Very well then. Come right back here and have a seat.
I wait. The Physician's Assistant comes in. She shows concern over my baby's poorly developed heart. She immediately takes my information and writes up the required referrals that I need. She tells me modern medicine is amazing and my baby will be healed in no time. (I practically snort. She should not be making promises like that.) She sends me on my way out the door.
I try to breeze past checkout, because I know what's coming.
Stupid Receptionist: Here is your insurance card, Shaina. That will be 20 dollars for copay.
Brilliant Former Insurance Biller who knew this would happen (me): I came in just for a referral. Not an examination.
Stupid Receptionist: Yes, but you saw the doctor. That means it was an examination. 20 dollars please.
Annoyed Pregnant Lady (me): That is because you FORCED me to come in to see the doctor, when I know perfectly well that this could have been done over the phone. However, you wouldn't allow me to do it over the phone, and required me to show up in person. I repeat, I was not examined. The patient isn't even technically me, so I will NOT pay a copay simply to get a referral.
Sick Male Patient in the waiting room: (Looks terrified at the confrontation)
Stupid Receptionist #2 chimes in: But that is how we bill. You come in to see us, and therefore you must pay a copay.
Fired up Pregnant Lady (me): I will not pay a copay for something that should have been done over the phone. I refuse to.
Stupid Receptionist #2: Well, I can leave a note for our billing person, and see what they say about this.
Me, walking out the door: Fine.