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Referrals and Authorizations
Many insurance plans utilize some sort of
“managed care” arrangement to operate their business even if they do not
refer to themselves as an “HMO”. The two basic parts of managed care
that may impact you as a patient are referrals and authorizations.
A referral is a process used by insurance
companies to monitor patient access to specialists such as North Florida
Women’s Physicians. A referral is required by many traditional HMO
products. Health Options, Healthplan Southeast, and Avmed are just a
few of the companies we are contracted with which require a referral
before you can schedule an appointment with our physicians. Other plans
such as Blue Cross Blue Shield Care Manager do not specifically require
a referral but they will provide you with much higher benefits and you
will have to pay much less if you do obtain a referral.
A referral is obtained by contacting your
Primary Care Physician. This is the doctor you chose, or the insurance
company assigned you, who is responsible for monitoring your overall
health and wellness. It is your responsibility to contact your primary
care physician in order to obtain an appropriate referral prior to
making an appointment with our office.
Unfortunately, we cannot obtain this
referral for you, this is something that you must do yourself. In many
cases your primary care physician may want to see or at least speak with
you first before they will issue a referral. It is very important,
therefore, that you contact your primary care physician and find out what
his/her rules are regarding referrals as soon as you are assigned to
that physician. That way you won’t be disappointed or suffer any delay
in treatment when you need a referral and find out then that you have to
meet your primary care doctor first.
If you see our physicians without
obtaining a referral when one is needed it is likely that your insurance
company will refuse to pay your benefits. If this happens,
unfortunately, you will have to pay for any charges from that visit.
That is why it is so important that you make certain to obtain any
required referrals prior to visiting our practice. No one wants to end
up paying for services which would have been covered by their insurance
company if they had only followed the rules established by that company.
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