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darkangl187 t1_iy54lsy wrote

It’s most likely the referral being out that far is bc the specialists are very booked. Is she losing weight? She has to become more “critical” for her to get bumped on the schedule. Otherwise unfortunately she has to wait. Unless she can call other GI specialists further away….and is willing to drive. Good luck.

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TyrconnellFL t1_iy55ax9 wrote

Not enough information. Referral to what and who? If the ER referred her rather than admitting her, they have determined that it isn’t an emergency and she can wait. Otherwise she can talk to insurance but they can’t make there be sooner availability within network.

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AllTheyEatIsLettuce t1_iy5irif wrote

>I get that it’s not the kind of emergency

It's not any kind of emergency if the customer received a recommendation to seek care elsewhere other than an emergency department/room. That's the insurance seller's position and it's not going to blink.

What you're asking (?) the insurance seller to do is make what's called a "network gap exception" in order for the customer to seek necessary health care from "OON" vendor(s) and have the insurance seller reimburse the vendor(s) at the "IN" rate. Assuming the vendor(s) agree to (1) take/accept/participate in the insurance seller's reimbursement scheme in general and (2) accept the reimbursement rate(s) for <something_here> in particular.

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eckliptic t1_iy5o4k5 wrote

Does her plan cover the nearest tertiary academic center ? If she literally can’t keep food down that’s enough for an inpatient admission and likely scope

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estherstein t1_iy5uj2a wrote

How much did she weigh to start with? That doesn't make mathematical sense unless she has the weight to lose (not that this isn't a serious medical issue, but she won't starve that way which is important to know).

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bros402 t1_iy5utk1 wrote

Need more info. What kind of specialist? ER referring her means it isn't considered an emergency.

Call the specialist and ask to be called if they have a cancellation and she should be ready to head there at a moment's notice, so hopefully she lives close. Has she called other specialists of that kind on the plan? Since it is an issue keeping food down, it's either ENT or GI - and neither of those are super uncommon, so she should call every single one on her plan and then get her GP to write a referral to whoever has the soonest appointment.

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estherstein t1_iy5vrqm wrote

I'm in recovery for atypical anorexia, I'm 100% aware of that- I'm just thinking practically how much immediate danger OP's friend is in. She needs medical care obviously.

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Remote-Grape t1_iy64k3x wrote

I struggle to believe that there is only 1 specialist in network and if there is and they have no availability until February, have your friend call their insurance to ask about an In-Network Exception, sometimes called a GAP Exception. Insurance companies will grant these if there are no available in-network providers within a certain distance with any reasonable availability.

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