REFERRAL FAQ

Does my child need a referral to go to a specialist?
A: Most specialists require a physician-to-physician referral. Due to this, it is our office policy that the child be seen in our office within the past year for a well child check or within the past six months before a referral can be started.
B: There are some insurance companies which require referrals from the primary care physician before being seen by a specialist. It is the patient responsibility to understand the terms and conditions of their insurance policy.

If I have PCCM Medicaid will I need a referral to see anyone other than my primary care physician?
A: Yes. Please be aware that a referral needs to go through our referral process. A referral will not be given if an appointment is made without the knowledge of our office.

Can I go to Urgent Care if appointment times are inconvenient at your office and a referral will be sent?
A: If appointments are unavailable at our office, we will send a referral to Urgent Care per patient request. This would be for times the office is closed or if a nurse has documented on the chart that all appointments are full.

What is the process of a referral?
A:
1. The physician gives us the order to start a referral.
2. We secure a referral if needed from the insurance company which may take a few days depending on the insurance.
3. Patient may need to get any labs or x-rays the specialist requires.
4. We contact the specialist’s office and fax any paperwork that they need. Many times we have to wait on the specialist to review records, make the appointment and contact us with that appointment.
5. We call the parents with the appointment time.

How long does it take to get an appointment with a specialist?
A: Each referral will be handled promptly and/or according to specialist. Please allow the referral office a few business days to start the referral process. Some offices may be fast to respond while others require a review process by the specialist before an appointment will be scheduled. It is not uncommon for a referral to take up to two months to complete.

If I see a specialist on a regular basis and need a referral, will you automatically renew my referral to them?
A: No. It is the patient’s responsibility to notify our office that the referral will need to be renewed before the expiration date.

I am at the specialist’s office and we changed insurance and now need a referral from the insurance company. Why can’t you fax over one now?
A: It is the patient’s responsibility to make sure that our office has notification of any insurance change. It is also the responsibility of the patient to know and understand the terms and conditions of their insurance.

Please be sure to correct and make changes to the demographic sheet at the time of check-in. This information is vital when contacting patients with dates and times of appointments, as well as receiving correct insurance information.