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Understanding Referrals
What is a referral?
Many patients participate in HMO plans, where they are required to select a Primary Care Physician (PCP). Our physicians act as the PCP for patients who are enrolled in HMO plans. One of the drawbacks of selecting an HMO plan, is that you are generally not allowed to see any physician that you would like. HMO's require that you must receive a referral to see a specialist and that when appropriate, we must complete the paperwork necessary for this to happen.
What kind of work does my PCP have to do to complete my referral paperwork?
Many of our patients do not have to wait for us to get approval from the HMO to see a specialist. However, for those that do, the process in general goes like this. Once it has been determines that you need to see a specialist, one of our providers will complete a referral form. In most cases you will proceed to the referral coordinator office. The referral coordinator will then contact your HMO using whatever procedures or rules established by the HMO. Depending upon you HMO, this part of the process can take a 5 minutes or 30 minutes. Sometimes they will ask that we send over copies of your chart before they will approve the referral. Our goal is to make sure that you leave our office with everything that you need to see the specialist.
What is a STAT referral?
Occasionally, one of our providers will diagnose a medical problem that requires urgent evaluation or treatment by a specialist. When this occurs, the provider will contact the specialist directly to discuss the problem and will ask that the specialist make space in their schedules to see our patient quickly. The referral coordinators will follow the same procedure as usual. In rare cases and only when the physician orders the patient to proceed directly to the specialist's office, they will complete the paperwork while the patient is in route.
What happens if the specialist needs to send me to another physician?
It is sometimes necessary for specialists to refer our patients to other specialists or sub-specialists to diagnose and/or treat their problem. If this happens, the specialist will either provide you or send over any relevant clinical notes. You will then need to stop by our office (No Appointment is Necessary) and we will complete your paperwork. The process usually just takes a few minutes. However, some HMOs have tedious referral processes and may require more time.
What is the provider wants to wait for the lab results before referring me to a specialist?
Sometimes your provider will need to wait for the results of lab tests or other ancillary tests in order to determine whether or not you need to see a specialist. If this is the case, our office will notify you after receiving the results of the test. You will to need to stop by our referral process (No Appointment Necessary) and we will complete the referral.
Is the referral department open during your night clinic or on Saturday?
The Referral Department is open from 8AM to 5PM Monday through Friday. If you are seen during our night clinic or Saturday clinic, the provider will prepare the referral request and it will be processed in most cases by the next business day. These referrals may take up to 7 business days to complete because patients who are present in person will be given first priority.
My referrals are taking too long. What can I do about it?
All insurance plans have rules. The most important thing you can do is to understand the rules of your plan. We encounter many patients who focus only on the cost of the plan when they select it. While this works well for those that rarely need medical services there are usually drawbacks that become apparent once medical services are needed. PPO plans or traditional Indemnity plans offer the widest choice and do not require referrals. If you find that your referrals are taking to much time, the best thing you can do is to select a PPO plan during enrollment. Some employers do not offer a choice of plans in which case the best thing you can do is to inform your employer of the delay. You and your employer are the customers of the insurance company. You pay their bills. Therefore, you have much more clout when addressing problems than we do.
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