Referrals

You may have coverage from an HMO which requires you to get referrals before you see a specialist. Rules regarding referrals are determined by the HMO you have chosen. Our staff requires at least two business days to pull your chart, check your coverage, write up your referral, and submit it to the doctor for signature.

Bear in mind also that we get about 100 requests for referrals every day. Insurers with "electronic referrals" such as Aetna US Healthcare or Cigna require an extra day for your referral to be forwarded by their electronic clearinghouses, etc. We must keep our fax line open for incoming faxes and often encounter busy signals at the faxes we are trying to reach. Therefore, except for emergencies, faxing is done during off-hours, usually early the next morning.

In Pennsylvania, it is not necessary to get a referral to see a gynecologist except for problems that are also handled by non-gynecological specialists (cancer or urination problems) or for infertility (an optional coverage). Most HMO's also do not require referrals for routine eye check-ups and glasses if you have vision coverage; if the eye doctor's office says you need a referral, he/she may not accept that insurer for routine check-ups, but only for medical/surgical problems.

If you are requesting a referral for a problem the doctor does not already know about or to a doctor to which you have not previously been referred, do not schedule an appointment without checking with us to make sure your insurer will cover it. Do not rely on any specialist or insurance representative who tells you, "Just get a referral from your doctor," as they sometimes instruct their staff to say that rather than hire people with extensive knowlege of your insurance companies policies to answer telephones.