If your physician determines that you need specialized care, such as cardiology or dermatology, a referral will be made to a specialist.
Referrals are required by your managed care health plan. We initiate referrals but it is your insurance company that authorizes the referrals. A written referral informs the health plan that your Physician is making a request to send you outside the office for consultation or testing. Referrals from your Physician and Authorizations by your insurance company are also needed for retroactive services such as Urgent Care visits and ambulance services.
We want your insurance company to work to your advantage. Our Referral Coordinators can assist you with questions about your processed referral.
You can reach the Referral Department by calling (619) 644-6542 or (619) 644-6527
1. Why do I need a referral?
Your insurance company makes sure you are eligible for the requested services before you are cared for by the specialist. A referral on file authorizes payment to the specialist. Without an authorized referral you may be responsible for paying for all the services that were provided.
2. How long does it take to get a referral?
This depends on the service ordered, but referrals can be obtained as quickly as the same day for emergency services. Non-emergent referrals may take several days to process. If approved, the referral coordinator will give you the name, address and telephone number of the physician you have been referred to, along with a referral number, so you can make your appointment.
3. My doctor says I need a specialist isn't that enough?
No, it is not for many insurance companies. If the requested referral is denied, both you and the physician will receive notification of the denial. Please read the denial letter carefully as it tells you the reason for denial, and what you need to do if you need to appeal the decision. Each insurance carrier has different rules and guidelines. Let us help you and your doctor get the most from your insurance carrier by using the correct doctors for referral and contracted support services.
4. If have an emergency, what do I need to do about authorization for treatment?
If it is life-threatening, call 911 or go directly to the emergency room. The next day, call your Primary Care Physician. If you are seriously ill after office hours, call the office and the doctor on call will discuss your problem with you. Some problems may be cared for over the phone. Some problems may need an emergency room or urgent care visit.
PLEASE BRING YOUR INSURANCE CARD TO THE OFFICE FOR EVERY ENCOUNTER