@contentandwell, Yes, JK, having a good relationship with the doc does make a decision to change much harder...especially for one who dreads change anyway. smiles Thanks to the confidence building suggestions from you, @johnbishop, @merpreb, @sunnyflower,@sueinmn, @colleenyoung, I am happy to report that my pcp approved my second request for an endo. referral! Started with 1 Big Thk U and 1 Big Request, I read to doc my "Plea statement/reasons for referral request" lol and she said "yes" to the referral! BIG relief and you guys get the credit.

No reference to her earlier denial and the fact that she had a young intern shadowing her may have contributed. I also said another opinion might not change anything during my yr off from Reclast but it would help "the worry wart's" peace of mind to know I'd tried all I could to add to my bone tool box. I wonder if she realized how stressful her first denial was and if reading out my family history and reasons for wanting another opinion made the difference.

Had placed 2 direct calls to Endo. offices about requiring referrals and accepting new patients and both required referrals and had closed practices.

A good friend suggested that the denials might be due to the fact that I was in a "managed care system". That sent me for more info. on "managed health care" and I learned more from: https://www.fool.com/investing/general/2015/10/06/what-is-managed-care.aspx.

My state retired teachers plan started at retirement with Aetna, moved to Humana, and recently changed to United Health. The last two are Medicare Advantaged Plans. I'm still not sure if it is just a local decision to require doc referrals to specialists or my particular ins plans but neither of the 2 endo offices asked about my ins. just my name and birthdate.

Local friends with other ins and direct requests for other specialists have also been told referrals were needed. It seems odd that members in other locations have suggested that Medicare patients might not need a referral. Just happy that the doc agreed to the request and will now play a "wait & see" about how the next year goes. Sending cyber hugs to each of you for your help and reassurance. Fiesty