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It’s most likely the referral being out that far is bc the specialists are very booked. Is she losing weight? She has to become more “critical” for her to get bumped on the schedule. Otherwise unfortunately she has to wait. Unless she can call other GI specialists further away….and is willing to drive. Good luck.

Not enough information. Referral to what and who? If the ER referred her rather than admitting her, they have determined that it isn’t an emergency and she can wait. Otherwise she can talk to insurance but they can’t make there be sooner availability within network.

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Personally I would call the place and see if with more information regarding her clinical picture they would bump her or overbook their provider to be seen.

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Did the ER consider checking her blood sugar?

Find a specialist and ask if they have uninsured prices. What is the budget that she can afford?

>I get that it’s not the kind of emergency

It's not any kind of emergency if the customer received a recommendation to seek care elsewhere other than an emergency department/room. That's the insurance seller's position and it's not going to blink.

What you're asking (?) the insurance seller to do is make what's called a "network gap exception" in order for the customer to seek necessary health care from "OON" vendor(s) and have the insurance seller reimburse the vendor(s) at the "IN" rate. Assuming the vendor(s) agree to (1) take/accept/participate in the insurance seller's reimbursement scheme in general and (2) accept the reimbursement rate(s) for <something_here> in particular.

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Does her plan cover the nearest tertiary academic center ? If she literally can’t keep food down that’s enough for an inpatient admission and likely scope

How much did she weigh to start with? That doesn't make mathematical sense unless she has the weight to lose (not that this isn't a serious medical issue, but she won't starve that way which is important to know).

Need more info. What kind of specialist? ER referring her means it isn't considered an emergency.

Call the specialist and ask to be called if they have a cancellation and she should be ready to head there at a moment's notice, so hopefully she lives close. Has she called other specialists of that kind on the plan? Since it is an issue keeping food down, it's either ENT or GI - and neither of those are super uncommon, so she should call every single one on her plan and then get her GP to write a referral to whoever has the soonest appointment.

once you hit 10% it's a medical condition

I'm in recovery for atypical anorexia, I'm 100% aware of that- I'm just thinking practically how much immediate danger OP's friend is in. She needs medical care obviously.

Hopefully OPs friend can see someone soon. I posted a comment that I hope will help OP and OP's friend.

I struggle to believe that there is only 1 specialist in network and if there is and they have no availability until February, have your friend call their insurance to ask about an In-Network Exception, sometimes called a GAP Exception. Insurance companies will grant these if there are no available in-network providers within a certain distance with any reasonable availability.

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