If You Need A Referral, Please Read Carefully And Call Us If You Need Help.
WHAT IS A REFERRAL?
If we feel that your child needs extra workup or needs to see another doctor to help with care, a referral will be made. This is where we may submit medical information to a patient’s health plan and a sub specialist and receive a “preauthorization” for your child to receive non-primary care services, such as those of a specialist, hospital or a CT or MRI. Most health plans require preauthorization to ensure payment for covered benefits. Please be advised that insurance companies REQUIRE a 72 hour period for them to process the referral in their system. We will always endeavor to put a referral in quickly (usually within one business day).
WHY IS A REFERRAL NEEDED?
Health plans require that your PCP (Primary Care Physician) obtain prior approval so that your non-primary care services may be covered. If the referral has not been approved prior to the visit, specialists will often require payment by the parent/patient in order for the child to be seen. It is very important to understand that Pediatric Affiliates gives referrals ONLY if our providers deem it necessary. If a sub specialist asks you to come in for evaluation without a PRIOR preauthorization from us, we cannot give a referral. Likewise, if a parent makes an appointment with a sub-specialist without a referral from us, the referral will, most likely, be denied.
HOW CAN I GET A REFERRAL?
We need to make the referral. Patients cannot refer themselves to a specialist. We will contact your health plan and request preauthorization but please realize that:
- Approval may take 3-5 working days.
- We will contact you with your preauthorization information.
- You then can make an appointment with the approved specialist or facility.
- Please notify us prior to your first visit if neither you nor the specialist has received the preauthorization information.
- Please keep us informed of any insurance changes.