Do I need a referral to take my daughter to a pediatric cardiologist (Illinois health connect insurance)?

Question

My daughter has a heart murmur, and she's 4 months old. Her pediatrician basically said "not to worry". When she was born the pediatrician (a differnt one) said that if it was still there a few weeks after birth she'd probably be referred to get an echocardiogram.

At her 4 month appt, the doctor still heard the murmur, but called for another doc to come and listen to it to review. The second doctor sort of said "oh well I can't hear it but it's probably nothing" (my daughter had just had shots and was screaming and crying).

They together concluded that they would not refer my daughter to cardiology.

I'm under the Illinois Health Connect insurance plan, and I'm not sure how I would go about getting her to cardiology. I think I need a referral, but I can't get a referral from her pediatrician, because she won't give me one. Her pediatrician is also going to a new hosp. but my appt with the new one isn't for two months.

What would you do?

Answer 1

Your health insurance card should have a phone number for members to call customer service to inquire about such questions as this one.  I would contact them and ask.  Also, when you enrolled in your insurance the insurance company should have sent you a booklet about covered services and if you would need a referral for certain services.  If there is no number on your card and you do not have a booklet whatever agency or person that issued this plan to you is who I would contact.  Did you give your insurance information to your doctor so they can bill your insurance claims?  They too should have some type of contact number on file to reach them.  I would explain to your pediatrician that even though both her and another doctor listened to your childs heart you would like to refer her to a cardiologist to rule out any problem and give you peace of mind regarding this.  If she doesnt give you a referral mention that you may consider switching doctors and if need be take her to another doctor willing to see you and give you a referral.  If you find that you dont need a referral make an appt. with a cardiologist and take her in.  It's your daughters health and a good portion of the time we as health care consumers have to be very proactive in obtaining what we feel is best for us.  Best Wishes.

Answer 2

if i were you, i would wait until the new pediatrician takes over, because you are going to need a referral. i have Illinois connect as well. my best friend had a premature baby weighing one pound and eight ounces, and she was born with a heart murmur. she is now eleven months old and she is just now scheduled for surgery. she had this murmur for along time and nothing happened to her.sometimes heart murmurs close on their own. i wouldn't be afraid or alarmed at this point because she is still young. it is more dangerous the older you become, because the hole gets bigger. wait two more months and ask for her new doctor to check her. i am pretty sure that this new doctor is more caring than the other one. i wish you luck and hope the baby gets better soon. i will keep you and your baby in my prayers.

Answer 3

I would call your insurance company and ask them.  If you do need the referral, call the pediatrician back and say that you want a referral or else you will see another doctor for it.  If they won't give it to you, call around to other pediatricians until you find one that will see her immediately, then ask them for the referral.  If they also won't give you a referral, then maybe it really isn't a concern.  Good luck.