Some of the insurance plans require a referral from a primary care physician for specialty services, diagnostic services, rehabilitation services, etc. Each plan is different. You should be familiar with the requirements of your plan concerning referrals. There may be certain procedures or treatments that can be administered by the primary care physician as effectively as a specialist. For this reason, we as your primary care physicians need to make a medical determination if a referral is required.

• You need to know whether your insurance plan requires a referral for specialty visits.
• If referrals are required by your insurance, please do not make appointments with specialty physician offices without a referral. Managed care plans require that your primary care physician make the determination whether a referral is needed or not.
• If the insurance determines that the primary care physician did not approve the appointment, then you may be responsible for the entire bill from the specialist.
• Please be patient with our staff when requesting referrals. We receive numerous requests and must be careful to accurately complete the paperwork.
• Many insurance companies require pre-certifications and prior authorizations for diagnostic testing such as CT Scans, MRIs, etc. You need to be aware of what is required by your insurance company.

If you have been instructed by one of our physicians or our answering service to seek care at an emergency room or after hours clinic, your insurance may require a referral or may not approve the visit. Since each plan is different, it is very important that you become familiar with your plan's requirements regarding emergency care. No one wants to worry about financial responsibilities during an emergency situation, so it is best to know the requirements ahead of time. If your insurance requires a referral for an ER visit, please contact our office on the next business day. You must notify our office of any ER visit to be sure that it will be covered.