Referrals

1. Referrals to Specialists
   
   
   1. I refer you: When I refer you to a specialist, I will print out a referral request form. You will give the referral request form to our referrals specialist. The referrals specialist will contact your insurance company and get the referral approved.
      
   2. Another doctor refers you: When another doctor refers you to a specialist, you may need a referral from our office. This is because, with some insurance plans, the primary care doctor's office does all referrals. If that's the case, just call our office and ask to speak to the referrals specialist. In some such cases, you may be asked to come see me first.
   
   
   3. You refer yourself: Quite often, when a patient decides to see a specialist, the primary care doctor will ask to see the patient first. There are 3 reasons for this:
      1. As gatekeeper, the primary care doctor has the responsibility to keep health care costs down. If the problem can be solved by the primary care doctor, the problem will be solved more economically.
      2. By approving the referral, the primary care doctor is putting his reputation on the line. If the referral is inappropriate, and the patient's health is adversely affected by a delay in treatment, the primary care doctor could be held liable. An example is a patient who is having chest pain wanting a referral to a cardiologist, when it's in the patient's best interest to just go to the emergency room for immediate treatment.
      3. The specialist to whom the patient has decided to go may not be the right specialist to solve the problem.


2. Referrals for Tests

   Some insurance companies require referrals be obtained even for tests, such as labs and imaging studies.

   In this case, significant delays can result. An example is the patient with excruciating back pain who needs an MRI. Without an MRI, the neurosurgeon will not be able to tell whether an operation is warranted. Sometimes MRI's are delayed for days to weeks while the insurance company takes its time deciding whether the MRI will be authorized.

   Sometimes the test is not authorized by the insurance company at all. MRI's are frequently denied because the insurance company thinks physical therapy is all that's needed. The doctor may know that physical therapy is not the answer, but the insurance company representative on the telephone (who in many cases does not even have a college degree) denies the MRI anyway.

   If your test requires a referral, we will do everything in our power to get the test approved by the insurance company.