Getting a referral from your primary care physician shouldn't be difficult, but sometimes it is. Dealing with insurance companies and figuring out exactly what you need to do in order to have your visit covered is increasingly hard and time consuming, especially given the upheaval in the insurance industry. There are horror stories out there about people trying and failing to get referrals, and while our advice might not help everyone, it's solid advice on how to go about getting referred.
If your health insurance plan is an HMO, or health maintenance organization, you probably know that your primary care physician coordinates your health care services. Your doctor keeps track of your medical records and provides routine care.
But what if you need to see a specialist? For most, but not all, HMO plans, you’ll need a referral from your primary care physician before you can see any other health care professional (except in an emergency). If your plan requires a referral and you don’t get one first, your insurance won’t cover the cost to see the specialist.
For example, if you have foot pain, you shouldn’t come straight to our office (as much as we'd like you to!). You should go to your primary care physician first for an exam. If your primary care physician can’t help you, he or she will give you a referral to a trusted podiatrist in your network.
A referral from your primary care physician can cover a period of time, with some plans being from 90 days to a year. Your primary care physician will let you know when your referral is approved, or your insurance will send you a letter in the mail.
Once you get your referral, your specialist can order any medically necessary treatment for you until the referral expires. If your specialist recommends that you see another specialist, you’ll need to coordinate a new referral with your primary care physician for that care.
Confused or scared? Don't be! If you call us we can help verify if you need prior approval.