Medicare precertification or referral - Will medicare not pay or cover your expenses without a referral?

Question:

My mom just moved a month ago from Arizona to North Carolina. She has had a heart defibrillator in her chest for the past 14 years. She is on Medicare and was prior to the move and was seeing a heart doctor regularly....we need to get her established with a heart doctor here in NC....I made the appointment without a General Practitioner's referral since this is not a new health issue but a continuing one. Does anyone know if Medicare will NOT pay for her appointment unless we get the referrral? The Heart Care Center that she is going to next week, says that they do not require a referal to see her, only that she needed to bring the records from her previous heart doctor in Arizona. I don't know anything about Medicare and my mom's seems confused about it also. Please help.

Answers:
Medicare can be confusing and I am sorry that your mom is having health problems. She is lucky to have you!

Whether you mom will need a referral or not will depend on the Medicare plan in which she is enrolled. Traditional Medicare will probably allow for the specialist without a referral, but to be on the safe side, you may want to call her GP's or her specialist's office in Arizona to ask about the need for a referral.

If your mom is enrolled in a Medicare plan other than traditional Medicare--like a Medicare HMO or a Medicare Advantage plan-- things might be trickier.

My advice is for you to find the Medicare documents that your mom has--including the name and the company of the Medicare supplemental policy that she has--and the Medicare Part D plan--if she is also enrolled in this. Call the phone numbers listed in these plans with your question(s)

If you are still confused or encounter problems with getting information or help from the companies, I would suggest that you contact your local Area Agency on Aging. Area Agencies on Aging are a national network--there is one serving the county where you live in North Carolina. Each area agency has professionals who can help you and your mom deal with this transition.

Area Agencies on Aging are one of the best kept secrets around for folks who need information about consumer issues and Medicare Part D . They work with a lot of seniors everyday, so they are great resources who probably know the "scoop" on the different plans. You can call toll-free 1-800-677-1116 to find how to contact the one serving you. You will most likely find the people there friendly and very helpful.

If you do contact your local Area Agency on Aging and like the help that they give you, let your local county officials and your folks in Congress know. Area Agencies on Aging are funded under the Older Americans Act and don't have big budgets!

Hope this helps! Best wishes and Good Luck!

I believe you do need a referal .

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Medicare precertification or referral - Will medicare not pay or cover your expenses without a referral?

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