My PCP won't refer me for specialist or authorize MRI

Absolutely possible.
Lions at the gate- sad but true.

I know it's not easy.If your doctor isn't listening to you, time for a new one. I have been a professional patient for 35 years. I've had 20 surgeries, I've had all the joints replaced due to terrible disease and not diagnosed until I was 16. By the time I was 25 I have no TMJ left, and had my first very scary surgery. I've been to a few really good doctors, who listened to me. They were women. Then I had rheumatologist who barely gave me the time of day, and they never touched me. Not to check my heart, lungs or my joints. But I was in Boston, right where I thought I needed to be. I go to the appointments, 2 hours away, the docs would ask how I feel, do I need any meds? That was it. One day, I had such severe pain in the back of my head I was resting my head on a pillow when the doctor came in, I told her of my symptoms, she literally tossed a prescription for muscle relaxers on the desk in front of me, and excused herself. She thought that's what I wanted and she had better things to do. I left in tears, never filled the script because I knew it wouldn't work. I did write to the head of the department, she must have had other complaints because they fired her, and she went on to making medicine, instead of working with patients. These were rheumatologist specializing in juvenile rheumatoid arthritis. I hope they treated the children better. I felt so defeated by this group of doctors.
But I digress. Seriously, find a new doctor. Or talk to your doctor and ask him/her why they refuse to order the test you need? If there's nothing that can be done to fix your problem they need to tell you that not just brush you off.

There is no pain like back and or neck pain!

If a PCP referral is required for insurance, call your insurance about the situation. They may have suggestions. Second opinion, neurosurgeon you saw, or other advice.

I would definitely be changing PCP providers. Advocacy for one's health deserves priority so quality healthcare decisions can be made - and that goes both ways! Your PCP should be open-minded and has a narrow scope of healthcare.

If you can, go back to the neurosurgeon since still in network. 'New' symptoms should merit this provider handling your care again. (I asked mine at an L4-5 fusion post op if he did neck surgery too.)

Don't know if much help, but I support ideas from others too. You deserve quality healthcare!

Came here to say this… Many specialists require a referral from your GP.

Straight medicare does not require a referral or even preapproval. With my medigap plan I also have zero copay for anything tho I'm totally aware being able to afford the $180/month for the medigap supplement is a luxury not everyone can afford. Medicare advantage plans are a nightmare for preapproval and getting worse but they offer perks to drag people in. If you don't take medigap within 6 months of turning 65, chances are you are stuck with an advantage plan the rest of your life.

But if your doctor denies you care, call your insurance company, next insurance commissioner, I've gone as high as the DC office of social security where the call came in as "US government" and they fixed things pronto.

Never accept no but you have to be willing to become a bear for self advocacy. If Your PCP is open to a lawsuit, they can continue to refuse you care. See I'm the type who would just say that to my insurance company, not necessarily the doctor as she could throw you out before you have someone new. I'm so sorry. They are not kings, queens or gods probably much to their chagrin. We have options. Just keep eating up the food chain. Your PCP is at the very bottom of the food chain tho they font want to think that, they are the one with the least power, not the most. At least in the US.

I've can tell you stories of things I've done for care that woulf curl your toes, but they worked. One even to reverse a terrible social security error and they were about to stop my checks in weeks and make me homeless. You would never believe what I did. My next check was 10 days late but their mistake didn't make me homeless. Never accept no from a doctor. "What do they call the medical student who graduated last in their class? Doctor!"

Medicare doesn't requite referrals but many specialists do. But an ortho walkin clinic can give you one. I did that this week. Spine dr wouldn't see me until someone else ordered an MRI. My PCP would have but I wanted an eval first and the exact right MRI ordered.
My best. Be

@bebold Ah - maybe THAT is the difference - it's not Medicare requiring the referral, it is the specialist! Thanks.

That's why it was so easy to get one from a walk-in clinic. Esp we have ortho walk-ins. Good luck. Be

Medicare advantage plans have to approve everything and I heard they are refusing nearly 75% of so much stuff. Before I retired, I had BC/BS as an advantage plan since I was on SSDI. I needed a rotator cuff repair. 4 parts to the surgery and BC only approved 3 parts. Surgeon said he wouldn't go in and not fix it all. He kind of did a sneaky thing with a friend radiologist, rewrote the MRI findings to match their language better and got it all approved. I was grateful.

You are on Medicare Advantage, an HMO, which is a total disadvantage to the consumer. Regular/Original Medicare doesn't require referrals to see specialists. I've had a back, hip, SCS implanted, shoulder and neck surgery - I went to the doctors/surgeons of my choice. Hopefully you can change at the next enrollment period 10/15 - 12/7. Preexisting conditions are covered by regular Medicare. Shop for a secondary policy (picks up the 20% Medicare doesn't cover) through a private insurance agent/broker to get the best rate.

I'm sorry you are going through this. I'd get a new PC doctor.

I'm on SSDI with limited income and rising expenses so cost is an issue but my income is too high to get Medicaid or a QMB+.

My plan pays my Part B premium which I'd have to pay switching to Original Medicare. I've contacted an insurance agent and did my own research and this is the issue. I've obtained a quote from every insurance company for the supplement plans. In my area (prices can greatly vary by region) the cheapest supplement plan was Plan N for $294.00/month (Medicare website says $390/month but my price was lower due to lower age. The other plan types either had very high deductibles, no Part B coverage or I wasn't eligible to enroll.

All plans "DON'T" cover any services for any conditions diagnosed within the last 6 months or earlier until you have been enrolled in the supplement plan for 6 months. I don't qualify for guaranteed issue rights until I turn 65.

So Part A and B services won't be covered on the supplement plan for the first 6 months plus I'll have to pay $458.90/month and wait 6 months. I've worked on my finances this week and I have no chance to find $460/month to spare. Maybe $200-250/month but that would be stretching it.

My advantage plan has not denied one service I've needed in the last 3 years which included multiple MRI/CTs, sleep studies, epidurals, RFAs, surgery, etc so I'm lucky in that regard. My prior PCP moved out of the area and I guess I picked the wrong PCP.

I did email via patient portal my concerns with pain not improving, issues peeing, CT results and feeling the need for MRIs of both my neck and lumbar, etc. I got a followup call today from the care manager asking specifics about where the pain and sensations are, how well can I manage the main without anymore pain meds, etc. They are going to give me injections of pain meds Friday and a 10 day supply of pain meds until I have my appointment.

My health record was updated today and states that all medical records currently under review, likely to need full imaging workup of entire spine, consider PM in interim if in office PM not effective, urinary symptoms concerning and likely needs surgery consult. Inform patient with followup call (they did call) that any severe or sudden worsening of any urinary or bowel symtoms to go to ER. Inform patient that if pain on side that radiates towards the chest suddenly gets severe go to ER. Advise patient that sudden onset of severe ripping/tearing pain in chest, neck and/or back, severe abdominal pain or leg pain/difficulty walking or stroke like symptoms to call EMS immediately. She noted in a different area that my CT showed aortic atherosclerosis and with CAD there is concern for possible aortic tear/dissection.

The system also noted an extension of my appointment time...they gave me two appointments back to back.

I'm hoping this information is showing that my concerns I sent using the patient portal has worked as some here have suggested.

Thanks for all the great feedback!