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Managed Care Referral Protocol
Welcome to our practice. We are pleased to be your Primary Care Physicians (PCP). As Board Certified Family Physicians we are trained to provide for most of the health care needs for you and your family. Should you need the services of another specialist, we will coordinate your care.
We participate with many Managed Care Plans, each of which has different benefits, rules and regulations. Most HMO plans require that you go to your (PCP) for your health care. Referrals are only made for those problems for which you and your PCP feel a specialist’s advice is warranted. Based on insurance companies' regulations, our Referral Protocol will assist you through the referral process.
REFERRAL PROTOCOL
- First schedule an appointment with your Primary Care Physician (PCP)
who will evaluate your medical problem.
- If you and your PCP decide that a referral is necessary our office will generate a referral for you. Most referrals are processed electronically eliminating the need for paper referrals. Your specialist is responsible for retrieving the electronic referral either electronically or by phone from your insurance company. MAMSI and CareFirst Blue Choice currently require paper referral. For these managed care plans we will generate a written referral and give you a copy to take to your specialist.
- It usually takes up to 5 days to process a referral. Do not schedule an appointment with your specialist before you have an approved referral. Retroactive referrals cannot be made and we cannot post date referrals. Make sure your specialist has your referral before he sees you.
- If your PCP designates your referral as a medical emergency it will be processed immediately.
- When you call to schedule your appointment with your specialist, ask if the specialist still participates with your insurance company.
- Referrals are good for a limited period of time and for a limited number of visits as dictated by your insurance company. Be familiar with your insurance company’s regulations regarding referrals. If your referral expires before you go to the specialist, your PCP must approve a new referral. This takes 5 days.
- Your PCP must receive a written treatment plan from your specialist in order to approve additional referrals to the same specialist.
- If your specialist orders blood work, have it done at the specialist’s office or your insurance company’s contract lab drawing station. We do not process blood work for specialists. Click here to locate convenient lab centers LabCorp and
Quest Diagnostics.
- Specialists usually may order further diagnostic tests without additional referrals from your PCP.
- Specialists usually may not directly refer to other specialists. Your PCP must first review the specialist’s written treatment plan in order to determine if additional referrals are necessary.
- Most participating specialists will not see you if you do not have an approved PCP referral at the time of your appointment. Please follow our Referral Protocol. We are not able to approve referrals unless you have followed the Protocol.
Exceptions will be made for true medical emergencies only.
Thank you for your cooperation.
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