So this is kind of a weird one and I’m wondering if anyone has any advice. I saw a specialist at the end of September that I had a referral to from my OB/GYN (between kids and issues I know her and have seen her way more frequently than my PCP). The specialist office told me I needed a referral from my PCP backdated a week since they didn’t think my OB/GYN referral counted. I put in the request to my PCP office and didn’t think much of it.

I got the bill late December saying my insurance company denied the claim and I’m on the hook for the full $600+ appointment. Between getting sick and the holidays, I called late January to my PCP’s office and asked what the issue was as they never contacted me with an issue. The woman I spoke to on the phone said she called the specialist’s office in September and they told her they didn’t need a referral since they had one on file, so they just didn’t put it in and never contacted me.

Now I’m fighting it and trying to get it resolved as this seems like a clear case of my doctors office should just backdate the referral since it was clearly their issue – and they’re refusing to backdate it. They’ve said I could appeal with my insurance company but they were unable to help me further.

Apart from getting a new PCP going forward, because I definitely am after this, do you know if there are any other resources I can reach out to to resolve this? We hit out $5k deductible last year so having a giant bill on top of it is a slap in the face.

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