Your Right to Request a Referral to a Specialist

At CNY Family Care, our doctors, physician assistants, and nurse practitioners are family care providers. That means they have experience and are highly educated in a wide range of medical conditions. Most of our patients find that experience and knowledge exactly what they need in a time of illness. For some patients with chronic or advanced illnesses, we need to refer them to a specialist. But your health isn’t just in our hands. You can (and should) take an active role in your health. If you think it’s time to see a specialist, ask us for a referral. If you want your primary care physician to refer you to a specialist, you can ask during your visit or call our referrals department directly at CNY Family Care (315) 634-6749.

When to Ask for a Referral

Some illnesses are easy to diagnose on the first visit. A very sore throat with a fever can be diagnosed and treated as strep throat with a quick test. Other illnesses aren’t that clear. Many diseases and chronic illnesses have similar symptoms. Our providers listen to your symptoms, ask questions, and order tests to single out the cause of your illness. That means some problems may take more than one visit to get a diagnosis.

If you’ve visited with your provider more than three times for the same issue and still don’t feel like you’re getting any closer to finding answers, it’s time to talk to your doctor about a specialist referral. Your primary care provider is a partner in your health. We want to see you feel better. Sometimes a doctor with specialized care in a specific area can provide new insight.

What to do Before Requesting a Referral

Before you ask your doctor for a referral, check with your insurance. Most insurance companies have a list of specialists they prefer. You’ll also want to know if seeing that specialist requires a referral from your insurance. You should call the specialist directly to check if you can make your appointment or if they require a referral directly from your physician. You can check out the potential providers and have an idea of who you’d like to request before your visit.

How to Request a Referral

It can feel awkward asking your doctor to refer you to someone else. Don’t let that stand in the way of better health for you. Your provider wants the best for your health. Primary care providers will continue to be involved in your health decisions even if you seek care from a specialist.

During your visit with your provider, ask if they think it’s time for you to see a specialist or let your doctor know you’re ready to see a specialist. Ask for your doctor’s recommendation of who to see and why that’s their preferred referral. If you do not want to see the specialist your doctor recommends, let them know who your insurance covers and who you would like to see.

If you want to request a referral outside of your visit, please call our referrals department at CNY Family Care at (315) 634-6749. Be aware that we will need to know all the following information to send a request to your PCP for the referral:

  • Specialist’s Name and/or Practice Name
  • Specialist’s phone number and address
  • Have you called that specialist already to ensure they participate with your insurance?
  • Have you called your insurance carrier to ask if your insurance requires a referral?
  • Why do you need to see this specialist (problem, diagnosis, symptoms, etc.)?
  • Have you already made an appointment with the specialist?

Questions About Your Referral

If you have any questions or concerns with your referral, please call the referrals department directly at (315) 634-6749. They are the best resource for you since they will be able to advise you in real-time what the status of your referral is.

Why is my referral taking so long?

CNY Family Care’s referral department will notify you through the patient portal when they have processed your referral. CNY Family Care will share important information about the referral directly with the other office, such as the reason for the referral, pertinent medical history, office notes, and test results. Once we have sent your medical information, we notify you (if you are not on the patient portal, we will mail you a letter). Once we have notified you that we have processed your referral, you can always facilitate an appointment by calling that specialist’s office directly.

Please note if you initiate the referral request, we send a request to your primary care physician for that referral. Please allow one week for your PCP to approve and create that referral or deny your referral request. If your PCP feels you do not need the referral, they will have one of their clinical staff call you and explain why they do not want you to see that specialist.

Currently, most specialists in Onondaga County do not process the referral they received from CNY Family Care for 1-2 weeks.

Most referrals for advanced imaging (CT/MRI) require prior authorization from your insurance carrier. Your insurance carrier will mail you a copy of the prior authorization approval or denial letter.

Most specialists will reach out to you directly through a phone call to make the appointment when they process the referral. Some mail you a letter advising that they have received your referral, approved it, but ask you to call them to schedule the first appointment. Others, especially referrals for mental health or substance abuse, will not contact you to make the first appointment. They require you to call them. Should the specialist we referred you to not call or mail paperwork to initiate an appointment, CNY Family Care will mail you a letter providing you with the office’s phone number and explaining that you must call them to schedule the initial appointment.