Two weeks ago I sprained my ankle pretty bad. After going to the ER and getting it x-rayed to find there is no break, I'd been having trouble putting weight on it for upwards of a week. I called my doctor and he told me to make an appointment with him, so I did. After my exam he decided I needed physical therapy on the ankle to help the mobility and whatnot. He told me rather than give me the physical therapy place, he'd put in a general referral with the insurance company, that I should call the insurance company and find who's covered, and then make an appointment.
The next day I called the insurance company. I have an HMO, so I not only have the health insurance, I am part of a medical group that provides for all my care. When I called the insurance she verified what medical group I was part of. Then she looked up a physical therapist that was close that was supposedly covered by the group and the insurance. She told me I should call the medical group also and clarify that I didn't need a specific referral to this physical therapy office and to ask whether a general referral would suffice.
I called the medical group and the lady on the phone was basically just saying "uh huh" to everything I asked without giving me more information. I asked her whether the general referral would work if I made an appointment at the physical therapy place provided by the insurance. My answer was "uh huh."
I called the physical therapist provided by the insurance and made an appointment.
About an hour later I get a phone call from another physical therapy office that says they received a referral from my doctor and would I like to make an appointment. I explained to her that my doctor had told me to contact the insurance to find a place and I'd already made an appointment somewhere else. She told me I should call the doctor's office and have them send the referral to the new place since they had received it. I was a little skeptical since I had been told the general referral worked, but I decided to cover my bases anyway.
I called the doctor's office to ask them to send the referral to the other physical therapy office and explained to her everything that had happened.
Secretary: Actually, your medical group only covers the 2nd physical therapy office. It's the only physical therapy office your medical group contracts with. Your insurance should have given you that information.
The secretary at the doctor's office was very nice and very apologetic about the confusion, but when all was said and done I had to make about 7 phone calls to make an appointment for this ankle. I feel like the insurance company and the medical group REALLY dropped the ball in giving me accurate information and wasted a considerable amount of my time trying to get this appointment scheduled.
I am really glad I found this out before going to the appointment at the first place scheduled, because I'd be out a whole lot of money after finding out that the provider was out of network.