Retroactive referral vs backdated referral

Hi all,

I goofed up and got an MRI which was referred by an urgent care provider, while my HMO insurance requires all referrals to come from my PCP. The insurance claim hasn't gone through yet and I caught it early so I have some time to hopefully fix my mistake. The customer service folks at BSBSM recommended that a retroactively written referral and/or authorization from my PCP may be enough to keep me from footing the bill. However, while researching retroactive referrals, I found that backdated referrals are highly unethical and potentially illegal. I'm not sure what the difference is – is it that a retro referral is more like "The MRI was medically necessary and appropriate and here is a referral for imaging despite the imaging already been completed" whereas a backdated referral basically forges a date to make it appear that the referral was written before the treatment when it in fact was not? I just want to make sure I'm using these terms right and don't accidentally request my doctor to do something unethical and illegal.

Thanks!

submitted by /u/BreadWhistle
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