Q. Do I need to obtain a referral each time I see a specialist?

A. Yes, if your insurance is through a managed care organization all visits to a specialist need to be authorized by your primary care physician (PCP), with the exception of PPO plans. Certain tests & procedures may also require prior authorization from your PCP. Please contact our office if you think you may need authorization for anything that you are scheduled for.

Q. How do I know if my referral or authorization has been completed and/or forwarded to a specialist of facility?

A. When you request a referral or authorization from our office, your referral will be processed within 5 business days, unless we contact you with questions or problems. We will fax your referral authorization directly to the specialist’s office or facility, and depending on your insurance type, your referral may also be available for them to access online. You may contact the specialist of facility to verify receipt of the referral.

Q. Is there a time limit on my referral?

A. Yes, your referral is valid for 90 days from the date issued (start dates tend to be the date you request the referral from us). This time period has been designated to offer you reasonable flexibility to schedule your appointment with the specialist.

Q. Do I need to call my primary care physician before receiving care at an emergency room or urgent care facility?

A. Yes, you must always contact your PCP first, unless your condition is life or limb threatening. After hours, if warranted by your condition, an on call physician can authorize your ER or urgent care visit via telephone. You may be responsible for the cost of services from an unauthorized trip to an ER or urgent care if the visit is not considered by your insurance company to be a true emergency. Obtaining prior authorization from your PCP can ensure payment and coverage.

Q. How far ahead should I call to request a referral?

A. As soon as you make an appointment with a specialist or testing facility. Our turnaround to process a referral or authorization is 5 business days. This means you must contact us at least 5 business days before your scheduled appointment. The specialist will then know they are authorized to see you. Failure to notify your PCP office prior to your appointment with a specialist may result in your having to pay out-of-pocket for the visit or test.