REFERRAL INFORMATION FOR THE PATIENT

Most HMO and some PPO carriers require either a referral or an prior authorization in order to be seen or treated by specialists and/or receive special tests and procedures.

1. A referral slip is given by the doctor to the front office staff stating the specialist or tests along with the diagnosis.
2. The referral requests are processed in the order received, by date. If an urgent referral is specified by the doctor, that referral is processed immediately, by our referral coordinators. That authorization request is submitted to the insurance company by fax or telephoned directly if needed. On average, referrals can take from one to two weeks depending upon your insurance company.
3. Depending on your insurance carrier’s guidelines, you will be either mailed the referral/authorization, telephoned or told at the time of your visit whether or not it has been approved.
4. A weekly follow-up is done to determine which insurance companies have not responded to our requests and then contacted for status.
5. Upon receipt of your referral/authorization approval, you will be notified by telephone or mailed a copy of the approved request. If we have not contacted you in seven to ten business days, please contact our office.
6. If you need a follow-up appointment with a specialist, contact us as soon as possible so that we may contact your insurance company. If you give 24 hour or same day requests to see a specialist you may need to reschedule your appointment with the specialist as we may not be able to get the authorization in time. Before you cancel any specialist appointment, check with one of our referral coordinators.
7. Due to insurance guidelines, your specialist must contact us and provide medical documentation to request further visits or referrals needed.