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Coverage denied at doctors office

Question asked by aka28144840949 on Aug 13, 2020
Latest reply on Aug 13, 2020 by humadmin5

I had a fall 8/3 that resulted in me being transported to the Emergency room. The doctors documented trauma to my knee and possible ligament damage and referred me to their Orthopedic Specialist or to follow up with my own. I made the appointment with my specialist for 8/7 and on the day of the visit I was told that my insurance DOES NOT cover x-rays etc because I was not referred by my “primary care” doctor. I paid close to $400 out of pocket as I wasn’t going to waste time arguing. As it turns out, I have a complete rupture of my Quadricep tendon and will require surgery. In an emergency, such as described, are they correct? How do I submit a claim for money I paid out of pocket? It is beyond me that I pay premiums for a policy that has not provided a benefit to this point. Please advise.