Help navigating a denied referral

Hoping someone can help me navigate an appeal process. I’m here in Illinois with an HMO plan. My son needed an appointment with a pediatric neurologist for an autism evaluation, but our network does not have one. Our pediatrician said no big deal and sent us to a specialist they have a contract with. They sent a referral and it was a 9 month wait. I checked with our insurance and they said they saw the referral in the system and we are good to go.

9 months later I call the office to check him in, and the receptionist informs me “by the way your pediatrician put in an internal referral, not an external. This visit won’t be covered by insurance. I immediately called the pediatrician office, they acknowledged the error, and they resubmitted the referral correctly. I spoke with our insurance and they said the review of the referral is pending.

Now I just received a message from our pediatrician that the new referral was denied. I don’t really know where to start. The neurologist wrote us referrals to in-network therapy. Will these be effected? Can I appeal to have the insurance cover the visit?

I’m already dealing with stress of the diagnosis and the overwhelming treatment plan, having to fight the insurance is the icing on the cake. Any help is appreciated

submitted by /u/CafeRaid
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