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
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
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
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?
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.