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Physician Referral Policy

Many employers select health insurance plans that require a patient’s primary care doctor to submit a referral before the patient can see certain specialists, undergo diagnostic testing, or be admitted to the hospital. While the primary care physician is required to request a referral we do not have the authority to approve the request. The approval of the referral is granted solely at the discretion of the insurance company. In an effort to better serve you, our patient, we have established guidelines to ensure the referral process is accomplished in a smooth and timely manner.

Referrals will only be made for established patients. An individual must be seen and evaluated by our providers prior to the processing of any referral request. We will handle all of the necessary paperwork to process a referral that has been initiated by one of our providers.

Your employer has chosen an insurance plan with a provider network. If appropriate, we will be glad to assist you in locating a specialist in your network. If you wish to see a physician who is not in your provider network it will be necessary for you to contact your insurance company and employer to request special permission. We can only refer you to a specialist out of your insurance network if the insurance company has not contracted with a physician of the needed specialty.

If you are requesting to continue care with a specialist you must call our office to initiate the referral process at least 5 business days prior to your appointment with the specialist. It is the responsibility of the specialist to provide a written request documenting the continued care plan. Once all the information has been received, our providers will make a decision to either initiate the referral or ask you to be seen by us prior to the referral. When a specialist schedules an appointment for you it is their responsibility to ensure the appropriate referral process is initiated. If the specialist fails to initiate the referral we will not be responsible for the referral process.

Same day referrals will only be done on an emergency basis.

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