Really, A Referral Needed?

Posted by in The Widow's Blog | 2 comments

Really, A Referral Needed?

Last week I suddenly developed a sore throat.

I decided that it could be healed with a little warm salt water gargling then throat lozenges and eventually just go away.

I did fairly well for a day or two then the fever hit with chills and body aches.  Of course, this all happened late evening on Friday when the Doctor’s office was closed.  Tylenol became my best friend that evening and night with a lot of gargling the trusted warm salt water.

The next morning, my sister-in-law, Cindy, called on another matter then asked how I was doing.  I told her what was going on with my throat and she insisted that she come to pick me up then take me to an Urgent Care.  The closest Urgent Care was in Lake Jackson, Texas a town about twenty miles from where I live.

After she picked me up we found the Urgent Care, Brazosport, went in, gave them my health insurance card and I began to fill out paperwork.   The woman at the desk called me back to the window then told me that they couldn’t see me because I had HMO insurance and needed a referral from my Doctor.  I am sure that the look I gave her was not one of approval.

I asked her, “Do you really think I would be here if my Doctor’s office was open?  You are an Urgent Care clinic for people to be seen when the Doctor’s Offices are closed.  I only need a referral for Specialists.”

Seeing in her eyes that the elevator had already stopped in the basement and might be bouncing, I asked her if there was another Urgent Care close by.  She told me that there was one across the street, so we loaded back up in the car and drove across the street.  Meanwhile, my friend Tylenol was wearing off and the fever was rising.

Once again, I approached a woman at the window in the Altus Urgent Care.  She looked at my insurance card then told me that I needed a referral.  Evidently crossing the street to another Urgent Care did not help with the elevator problem.  It seemed like people in the whole area had been exposed to this new form of sickness.

We left the building then Cindy suggested that we go in Walgreens and have them call the ER to see if they could see me.  The Pharmacy Technician could not believe the Urgent Cares turned me away.  After she talked to the ER, she told us they were waiting to see me.  I was seen and treated at the ER.  “Thang” is I don’t go to the ER because that it is for broken bones and such.

Monday morning early I called my insurance company and asked them what the deal was.  The lady on the phone told me that what they had told me was absolutely ridiculous and I could be seen by anyone anywhere in an emergency.  She told me that I only needed referrals for Specialists and if it should ever happen again to call them myself then hand my phone to the elevator ladies.  Bingo!

I did call the two Urgent Care ‘businesses’ and as gently as I could slowly, sweetly, stressing each word, told them that there is a number on the back of the insurance cards for them to call if they have questions.

 

2 Comments

  1. Shows how frustrating life can be sometimes, even when the answer seems so simple! How did things turn out for you? I guess I will have to wait for the next post to find out?

    • Actually, I was seen in the ER. My insurance company was not happy and very upset when I called them about it all and they are still actively pursuing getting these Urgent Cares surrounding me educated about what referral means on my insurance card. The referral is only for specialists.
      The Insurance company calls me once a week to update me. I am very humbled and totally impressed with Aetna Advantage Medicare. Awesome you ladies working for them.
      Thank you for your comment KB
      God Bless You and keep on sharing your postd. You are doing Awesome.
      Nancy

Leave a Reply

Your email address will not be published. Required fields are marked *