MDIPA experience - the need for referals

[Anonymous]

Hi,

We are going through fertility treatments and just changed from BCBS to MDIPA. Today at Shady Grove they told me I will need referrals to every single thing.... I went to my primary care physician to get referrals to Beta HCG (I am not sure how many I will need so I asked 5) and one ultrasound. Anyhow, the guy the prepared the referrals gave two papers, one listing the quantitative Beta every 48 hours (he actually wrote that on the paper) and another one for a "pelvic u/s"... I even told him I am not sure it is going to be pelvic because so far I only had intra-vaginal u/s...but he said "it is going to be pelvic; they are not putting anything inside there" (!) and as I got home I just noticed that the referral for the u/s is on a paper specific for Fairfax Radiology Centers and the blood work on a paper for LabCorp.

Now, SG has its own lab and u/s... and my primary care physician acted like if I was talking a strange language when I was explaining why I need those tests, etc.

On top of it, I had to pay $20.00 co-pay, what is ok considering the doctor had to see me...but will I have to pay $20.00 every time I need a referral? Plus the co-pay for whatever test/visitation with Shady Grove I need?

Anyhow, I would like to know if anyone had experience with that kind of situation? Will SG accept those "referrals" on papers specifically for LabCorp and Fairfax Radiology Center? And please, does anyone have a good/understanding primary care physician? One that understands at least a little bit about the mechanics of fertility treatment and how often we usually have to go in?

Thanks.

[Anonymous]

BTW, we like in the NoVa (Reston) area.

[Anonymous]

Live*

[Anonymous]

Yikes, I hate learning about all of this! We just switched from BCBS to MDIPA also. I have been going to Shady Grove for some time (4 IUI and 1 failed IVF). I'm really hoping the pre-approval for insurance coverage goes smoothly since I've been there for over a year now. I hope they already have all my stuff. I wish I could advise you on this. Are you new to Shady Grove? Do you have a good normal OBGYN to recommend in MDIPA network?

[Anonymous]

I just did my second IUI I LOVE my OB and I am VERY happy by the fact that he is in the MDIPA network. His name is Scott T. Forrest - phone # [phone] and his office is in Fairfax, VA.

www.drsallenandforrest.com

Good luck And if you find a good pcp let me know please.

[Anonymous]

OP - Are you sure you're getting accurate information from Shady Grove? I had a bad experience with them dealing with insurance and finally went to the person in the Rockville office who is in charge of my insurance plan - she straightened things out. I would try that.

[Anonymous]

When I went thru this last year, I had to get my PCP to give me a referral to Shady Grove for a consult. Then after my consult, SG requested pre-approval for my labs, etc. After my labs came back, SG requsted pre-approval for IVF. It worked pretty smoothly in all cases except for the initial referral from my PCP. Apparently this referral is a little bit different from the standard one. I ended up in a three way call with my PCP office and the MD IPA coordinator at SG (Rockvillre) and got it all worked out. It might be helpful to call MD IPA directly to see what they want.