Life & Health Insurance/referral

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Question
My daughter went to the hosp Fri night and was diagnosed with gall stones. The hosp said they would refer me to a general surgeon. I know how fast hospitals get things done: One day between now and never. Do I have to wait for them to refer me or can I call the primary care provider and get my own? I'm not sure what laws are or how insurance companies work. Do different companies have different rules, does it vary by state? She has dry heaves about a dozen times a day. I hate to put her through all that if I don't have to.

Answer
If the situation is dire, the hospital typically expedites that process. Most of the time, if you are on a PPO plan, referrals are not needed from a PCP. However, each hospital is different. Some require referrals from the specific hospital that is treating the patient. I would discuss that directly with the hospital and also contact your insurer to find out the quickest route to take. Insurance companies operate differently from state to state. In texas, referrals from PCP's will suffice if the insured is on a PPO plan. If the hospital tells you that is is ok to get a referral from your PCP, then I would take their word for it. Since the situation involves a child and an urgent matter, the hospital may work with you.  

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John Claborn

Expertise

Any question on individual or employee-sponsored health insurance, Term life insurance, or Medicare questions. I cannot answer any question involving investment funded life insurance or any government-sponsored entitlement question that does not involve a private insurance company.

Experience

Our agency has over 35 years of combined experience. I, personally have been in the insurance business for 6 years. I have dealt with every type of client out there, young and old.

Organizations
Texas Association of Health Underwriters Lubbock Association of Health Underwriters - Media/Communications Chair Young Professionals of Greater Lubbock Premier Networkers of Greater Lubbock (President)

Education/Credentials
Bachelor of Arts in Economics from Texas Tech University. Associates of Arts in Business Administration from Frank Phillips College.

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