TMI about me but dying for information update

[Wendy1985]

For all insurance agents just got new insurance my question is why will they only cover a therapist if you were referred by your primary

of course my doctor is not going to write the letter I was not with her when I got referred to therapy

 

[pweyl36]

With Ins co, you must see your family Doctor first to see if they can help you. If not then they will do a referral to a specialist. Most of the time a family doctor can help you.

 

[Wendy1985]

With Ins co, you must see your family Doctor first to see if they can help you. If not then they will do a referral to a specialist. Most of the time a family doctor can help you.

Last time I checked primary does not do mental health any more then my doctor does physical health

 

[barkley]

i can honestly say that i've never had an insurance policy with this provision. i've had ppo's and hmo's (where the primary care physician is the gatekeeper for referrals) but neither have ever required a referral for therapy (i'm assuming mental health type). i know that at different points in time certain mental health therapists were in short supply in our region so THEY only took new patients w/ a referral from a doctor but it wasn't a provision of the insurance policy.

 

[pweyl36]

Last time I checked primary does not do mental health any more then my doctor does physical health

Not necessarily, most gives meds. If a doctor feels it's past his expertise then they will refer a pt . Its cheaper for the ins co.

 

[Wendy1985]

i can honestly say that i've never had an insurance policy with this provision. i've had ppo's and hmo's (where the primary care physician is the gatekeeper for referrals) but neither have ever required a referral for therapy (i'm assuming mental health type). i know that at different points in time certain mental health therapists were in short supply in our region so THEY only took new patients w/ a referral from a doctor but it wasn't a provision of the insurance policy.

Not a new patient by a long shot been in and out of therapy seems 2002

 

[Meriweather]

My granddaughter sees a psycologist for her ADHD. Covered by her parents insurance and that person prescribes her medications.

 

[lanejudy]

There are variables involved:
1) the specific health plan, because health plans vary widely in what they cover and requirements to obtain that coverage
2) the patient's specific needs related to mental health. Many PEDs or PCPs will prescribe for ADHD and check-in with patients with "minor" MH issues -- of course depending on the issue. And I certainly don't mean to minimize anyone's health concern with the term "minor" which is why I put it in quotes. But there are other needs that the PED or PCP will suggest the patient find a therapist who can help more in-depth.

Honestly, if you have a concern and wish to restart (or continue?) visits to a mental health professional -- I don't see why your PCP wouldn't be willing to write a referral if required by either your new insurance or the MH practice. If that issue has been an on-again-off-again issue for you over the years, wouldn't it likely already be in your medical records with the primary - that you've mentioned it previously? If not, a simple discussion about your concerns and how the mental health professional has helped in the past should be all that's needed to get a referral.

 

[Colleen27]

I hate that plans with that provision. I'm under the ongoing care of a specialist related to a chronic/genetic eye condition. Every time we change insurance, which seems to be every couple years as DH's employer works to keep premiums reasonable, I have to go back to my primary doctor to get a new referral to see the same ophthalmologist who has been monitoring and treating this condition for the past 6+ years. It is a waste of time and money just to satisfy some new set of bean-counters, but if we want the insurance to pay, we have to jump through their hoops.

 

[nancipants]

I hate that plans with that provision. I'm under the ongoing care of a specialist related to a chronic/genetic eye condition. Every time we change insurance, which seems to be every couple years as DH's employer works to keep premiums reasonable, I have to go back to my primary doctor to get a new referral to see the same ophthalmologist who has been monitoring and treating this condition for the past 6+ years. It is a waste of time and money just to satisfy some new set of bean-counters, but if we want the insurance to pay, we have to jump through their hoops.

That's so frustrating. I am lucky that I've never had insurance that required referrals to see a specialist or I would be in the same position for my endocrinologist.

 

[lanejudy]

I have to go back to my primary doctor to get a new referral

It's been a while since I needed to request referrals, but I used to be able to make the request by phone. DD's primary knew of her various needs, and I'd simply say "she needs a referral to orthopedics" or whichever specialty. No new visit required as long as the issue was relatively current in the records with the primary. I guess that's another reason to make sure you have a regular annual and discuss everything going on, even if it's not something the primary treats.

 

[DisneyHardin]

It's totally dependent on what the provisions of your insurance are. My insurance doesn't require referrals for specialists (including therapists). Even if yours does require referrals, I'm sure you primary care doctor wouldn't hesitate to write the referral even if you are new patient.

 

[Wendy1985]

It's totally dependent on what the provisions of your insurance are. My insurance doesn't require referrals for specialists (including therapists). Even if yours does require referrals, I'm sure you primary care doctor wouldn't hesitate to write the referral even if you are new patient.

Neither have mine for the last 20 years that is why I was surprised this came up

 

[DisneyHardin]

Neither have mine for the last 20 years that is why I was surprised this came up

Sorry, I was confused by the wording of your original post. I thought you were asking if insurances required referrals, I now realize you are saying yours does require a referral. Did you ask your primary care and they refused, or are you assuming they will refuse?

 

[Wendy1985]

Sorry, I was confused by the wording of your original post. I thought you were asking if insurances required referrals, I now realize you are saying yours does require a referral. Did you ask your primary care and they refused, or are you assuming they will refuse?

I am assuming because she was not my doctor when I started therapy

 

[barkley]

I am assuming because she was not my doctor when I started therapy

she should have access to your prior medical records. even absent that-in my experience (and w/ a dh and 2 now adult kids all of us requiring therapy at one point or another) doctors seem much more willing these days to refer for therapy. my pcp as well as my oldest's don't even want to handle prescribing psychiatric medications b/c of what they feel is oversight they don't feel comfortable in their scope of practice handling. as a result a therapist treats and makes a recommendation for meds but there is an entirely separate physician who prescribes and oversees psychiatric meds (and has access to the other doctor's records to ensure nothing new is being prescribed that will have an adverse drug interaction).

at this point one us has-a therapist and 2 doctors that work cooperativly to coordinate mental health treatment and meds.

 

[Wendy1985]

So my mom and I talked and she got a leader from the psychiatrist he explained why I need therapy because he was the one who referred me and I am getting a new physician a little to happy about that

 

[LuvOrlando]

It is always upsetting to hear about obstacles to mental health care. So sorry to hear about the added stress you had to deal with, but it is good news that your Mom was able to help you sort it out.