WHY YOUR PRIMARY CARE PHYSICIAN MAY REFER YOU TO A SPECIALIST
An important part of coordinating your care is when your primary care physician (PCP) “refers” you to a specialist for services they cannot provide. Your PCP works with a variety of specialists who are considered, by your PCP, to be excellent doctors in their respective fields. When your PCP refers you to a specialist, they recommend you see a doctor whose opinion your PCP trusts and who your PCP feels is qualified to diagnose your specific condition. Your PCP and the specialist will communicate to ensure you receive the care you need.
REFERRALS and MANAGED CARE ISSUES:
At CNY Family Care, LLP we make every effort to cooperate with your managed care programs and their policies regarding referrals and pre-certification. We do this because we understand the benefits of HMO programs and the decreased costs to our patients because of HMO availability. However, one of the requirements of HMOs is to make referrals to specialists and to pre-certify various procedures and hospitalizations. We have agreed to follow these type of guidelines in order to participate with your insurance program. Please assist us in cooperating with your HMO or PPO program.
REFERRALS OUTSIDE THE OFFICE:
In some instances, our providers may refer a patient to a specialist outside our office for a consultation or testing. Please be sure to keep these appointments and contact us if you have to cancel or change any appointments. Within our office, all referrals are kept open and monitored until the corresponding result or consultation note has been provided to us. We track these to make sure each patient gets the needed care that was recommended by our providers. In addition, we make the necessary insurance provisions for each referral to make sure that your insurance company is aware that we have ordered these tests. This way your insurance coverage can be maximized. Some insurance companies may not pay for a referral to a specialist unless the referral is done by the Primary Care Physician.
- As a general rule, our practice will not make referrals to specialists if a patient has not been seen in our office for the specific problem related to the referral. IF YOU ARE A NEW PATIENT, you must first establish (be seen) in our office before we will make an out of office referral.
- Self-referrals (going to a specialist without being referred by your PCP) are typically not covered by manage care plans. If you self-refer, insurance companies will not allow us to “back date” a referral. We will not attempt to obtain a referral after the visit has occurred.
- If you call our office for a referral, you will (unless it is for an ongoing chronic issue) be required to come in and be seen by one of our providers.
- If you have been told that you will be contacted to schedule an appointment for testing, or to see a specialist and it has been more than a week, please follow up with our office.