Commercial managed care health plans typically require a referral form from your plan's designated primary care physician (PCP) before being seen by a specialist - like an ophthalmologist, neurologist, or endocrinologist.
Since you contract directly with your health insurance plan, it is your responsibility to be knowledgeable about your
health insurance plan and its requirements. This includes knowing whether a referral is needed each time you
visit our office.
Per your agreement with your insurance company, if your insurance company requires a referral to see a specialist, then it is your responsibility to obtain a referral when:
1) It is your first visit to our office 2) If your insurance company has changed or if your insurance plan has changed (such as from Cigna PPO to Cigna HMO). 3) If you change your primary care doctor or have never seen your primary care doctor. 4) If you have not been seen in our office in over a year. 5) If you are being seen for a new diagnosis or new problem.
Please contact your primary care physician's (PCP's) office at least 48 hours prior to your scheduled appointment with us (as early as possible would be most beneficial to you). This way your primary care physician's (PCP's) office will have adequate time to prepare and send a referral on your behalf to our office. Remember, this applies anytime you wish to see any specialist and is not unique to being seen in our office.
Our office will attempt to assist you, if needed, in obtaining a referral to be seen by our doctors. But, ultimately, this responsibility is designated to you by your agreement with your insurance plan.