I am confused about some of the things you have mentioned about quite how your insurance is a potential complicating factor in obtaining a diagnosis but I will give you my thoughts for what they are worth.

It's entirely possible to have chronic pain in a limb and not have CRPS. It's entirely possible to have chronic pain that has all the classic hallmarks of CRPS type nerve (or neuropathic) pain in that limb and not have CRPS. There are a whole series of other clinical signs and symptoms that must be present in order for a diagnosis of CRPS to be made. Those diagnostic criteria are clearly documented and generally accepted internationally.

For many people with post trauma or post surgical chronic nerve pain problems, the reality is that the therapeutic 'treatments' offered will be much the same as would be offered to someone diagnosed with CRPS. The drugs are the same, the physio and occupational therapy will be much the same and the potential need for psychological support may be similar. However, there can be a number of additional complicating signs and symptoms in CRPS that may warrant additional medication, procedures or management. These additional problems can be severely disabling and complex to manage in CRPS.

If CRPS is present, it is recommended that no invasive procedures are carried out on the affected limb or limbs so a CRPS diagnosis would normally preclude any further surgery unless it was an emergency. A knowledgable orthopaedic surgeon would (and should) be very reluctant to operate on a CRPS affected limb. That is not an issue for a non-CRPS chronic pain condition.

There is no reason that once you start your PT referral, that anyone "will have to say why" you have so much pain. There are vast numbers of people living with chronic pain who never get a reason, a diagnosis, a name or a cure for their pain. This can be the case even after endless tests and examinations. Don't assume you will get answers, you might, but it is as likely that you will never get any answers. Like so many things, diagnosis of the underlying cause of pain is notoriously difficult. I say this, not to be a total misery, but to forewarn you that you might need to be prepared to come to terms with the day to day reality of coping with your pain without a diagnosis plus any financial/admin difficulties this gives you in getting approvals from your insurers if you don't have a "label".

Orthopaedic surgeons are typically poor at recognising and diagnosing CRPS. If your surgeon is recommending further surgery then you need to be asking why - what exactly does he think the cause of this pain is and why will the next proposed surgery be treating that pain? Before going through with it, if there is a realistic possibility you meet the criteria for CRPS, then you would ideally be asking your PCP for a referral to a pain clinic to see a pain management specialist (often someone who has trained as an anaesthetist) or a rheumatologist since they do a lot of pain management by virtue of the types of painful conditions they deal with. Either way, the specialist would examine you and take a detailed history to try and rule CRPS in or out.

Sometimes it is diagnosed by neurologists (technically it is classified as a neurological condition) but that can be rather hit and miss unless you happen to know that the neurologist you are referred to has real, decent experience of CRPS. Is your neurologist saying that your insurance company won't pay for you to have a specific referral, examination and testing by a pain specialist to determine what he/she thinks the cause of your pain is?

I hope that this is of some help and I'm sorry if I have misunderstood anything you were saying. I'm sure other people will add their thoughts and if you have any questions, just ask.