As part of ongoing care, your child may be referred to another healthcare provider, usually a pediatric subspecialist, for further evaluation and ongoing treatment. Some insurance plans, including most HMO plans, require that we obtain their written approval before your child is seen by a specialist, undergoes additional medical services outside our office, or is admitted to the hospital. Our Referral Coordinator is available to help you obtain this approval to ensure that your claims for these services will be considered for payment by your insurance company.
To request a referral, you must have activated your portal account. All requests are now managed through the portal in compliance with HIPAA regulations. If you already have a portal account, please log in to the Patient Portal to communicate with the Referral Coordinator by secure messaging. We will provide you with a list of recommended providers for the particular service your child needs. It is your responsibility to make sure that the provider you choose is in network with your insurance plan. We will also ask that you make your child’s appointment with the specialist and then notify us, via your portal account, so we may obtain the referral authorization from your insurance plan and get it to your specialist’s office prior to your appointment. This process can take up to 24 hours for urgent referrals and up to seven days for routine referrals.
Be aware that referrals come from your health plan and many times we are not able to obtain them instantaneously; please do not call us from your specialist’s office to request the referral as we may not be able to fulfill your request at that time.
If you change insurance plans, the specialist your child may be currently seeing or has seen may not be contracted and in network with your new insurance plan, so please do not assume that you can see the same specialist. It is always wise to check with your new insurance carrier for the names of specialists in their network.
