Specialist refusing to see me without a referral!

This is just awful!
My husband was in New York City yesterday seeing a specialist at one of the hospitals. He’s dealing with a health issue that requires surgery, so he went in for his first consultation. He brought his referral along, but then, right in the middle of explaining things, the doctor basically tells him that with that referral, he can go ahead and do... well, you know... absolutely nothing! 😲
Look, I get it, the guy runs a private practice on the side, but when you show up to the hospital while he's on duty, shouldn't they be required to honor the referral?!
And then, to top it all off, he made it crystal clear to my husband that he'd end up having to pay for the surgery out of pocket too!

He hasn't given us a specific price tag yet, but still... the implication was there.
I called several other hospitals across the US, and everyone just points us back to this same hospital in New York City.
It's enough to drive you crazy!
What's the point of having health insurance and supplemental coverage then?
What are we supposed to do? 😢

Carol Fisher3 said:This is insane!
My husband was in New York City yesterday seeing a specialist at one of the hospitals. He’s got this health issue that requires surgery, so he went in for his first consultation. He brought his referral, but then this guy has the nerve to tell him straight to his face that with that referral, he can basically do whatever he wants!!!😲
Look, sure, the guy has a private practice too, but if you're going to his hospital while he's on call, shouldn't they honor the referral?!
And then he actually let my husband know that he'd have to pay for the surgery too!!!!!!!!!!

He hasn't officially asked for the cash yet, but still....
I called other hospitals all over the US, and everyone just points us back to this specific hospital in New York City.
It's driving me crazy!
What's the point of having health insurance and supplemental coverage then!?
What are we supposed to do!? 😢

Is it possible something is wrong with the referral? Like maybe there's a typo making it invalid?

Carol Fisher3 said:That's just awful...
My husband was over at a specialist's office in New York City yesterday—he’s dealing with a health issue that'll likely require surgery—and he was just there for his first consultation. He brought along his referral, but once he finally got some time with the doctor, he was told that with that specific paperwork... well, he can basically do whatever he wants...😲
So, sure—the doctor runs a private practice on the side, but when you're seeing him at the hospital during his shift, he still has to accept the referral... right? Or am I missing something...
It’s probably about time she makes it clear to her husband—that he’s going to have to cover the cost of the surgery too...

He hasn't actually asked for any payment yet—but still...
I called around to a few other hospitals across the US—everyone keeps pointing me toward that one specific facility in New York City...
It’s enough to drive you crazy...
So... are we looking at health insurance and supplemental coverage then...?
What should we do... any ideas? 😢

Under the old Health Care Act, doctors were actually allowed to run their own private practices at the hospital after their regular shifts ended... There was a lot of debate about whether that was ethical—people were really pushing to have that clause removed. I’m not entirely sure if they actually did it... I haven't had a chance to sit down and read through the new Health Care Act that went into effect on January 1st. Your best bet is probably just checking in with the Department of Health and Human Services or CMS—you should ask if doctors are still allowed to run private practices out of their hospital affiliations, or if those rules changed in the new law...

Carol Fisher3 said:This is just awful!
My husband was at a hospital in New York City yesterday seeing a specialist because he’s got this health issue that needs surgery, so he went in for his first consultation. He brought his referral along, but then the doctor basically tells him straight to his face that with that referral, he can basically do whatever he wants!!!😲
I mean, sure, the guy has a private practice on the side, but when you're visiting him at the hospital while he's on duty, shouldn't they honor the referral?!
And the kicker is HE TOLD MY HUSBAND THAT HE'D HAVE TO PAY FOR THE SURGERY TOO!!!!!!!!!!

He hasn't asked for a specific amount yet, but still....
I called a bunch of other hospitals across the US, and everyone just points us back to this one hospital in New York City.
It's enough to drive you crazy!
So what, do we need both major medical and supplemental insurance now!?
What are we even supposed to do!? 😢

Give us some more details...what's the deal here? Like, does he have to pay under the table? To CMS? Or to some third party?....

It is quite understandable, if you'll pardon my bluntness, that he was feeling rather frustrated when you arrived at the emergency room bearing nothing but a referral... you see, the ER is specifically designed to handle urgent, immediate medical crises, whereas standard check-ups and routine appointments are meant to be scheduled through a regular outpatient clinic. As for the costs associated with the surgery, without having any more specific details regarding the nature of the procedure itself, I simply cannot offer a meaningful comment on that matter.

It’s been quite a while since I first posted this, but I wanted to clear things up a bit. We’re talking about bimaxillary osteotomy here. I won’t name the specific doctor right now, but let me tell you, everything was already coordinated during the shift through another physician my husband was referred to. The referral was perfectly valid. Honestly, it just feels like they were trying to make sure the money went straight into one specific pocket because they act like they're the only ones capable of doing the procedure.
In the meantime, my husband found an orthodontist for his braces, who then referred him to a colleague practicing in San Francisco. That specialist works closely with the surgeons over at the Mayo Clinic, where these types of surgeries are performed too! So, about two years ago now, my husband went to San Francisco for the operation, and everything went smoothly. He didn't have to pay a single cent to the hospital or for the surgery itself... though he wasn't eligible for travel reimbursement since New York City is closer. And hey, while he was sorted, my little guy and I actually got to take a ten-day vacation by the coast. 😁 He managed to get everything resolved much faster than if we had stayed in NYC. He’ll be wearing braces soon, but he actually already had them removed last year. Apparently, if you try to go through the system in Brooklyn, the waiting list for an orthodontist is about two years long.
You really just have to dig around and find someone who actually knows more than the bureaucrats over at CMS... By the way, all the doctors and staff in San Francisco were incredibly kind and attentive. The surgeon even showed up on his day off during the weekend just to check on patients and see what they needed. It felt like being in a different country, not just a different city! You just have to stick to your guns and stay persistent. On top of that, the braces were going to cost nearly $20,000. But since my husband has dealt with this issue since he was a kid, thanks to a lot of hard work and pushing back, CMS actually approved both the braces and the surgery. Total costs ended up being around $40,000... anything is possible if you don't lose hope.

Call Apple in situations like this—they’ve come to my rescue every single time. I personally report everything that isn't up to standard. It actually worked out so well that I ended up getting some money back from a fee I paid for an appointment. I didn't even realize that was an option. Honestly, I wouldn't have known if I hadn't done my own research.