Referral Management FAQs

What are the benefits of staying in my PCP’s network? 

  • By choosing to stay in-network, you are allowing your primary care physician to provide you with better coordinated care with other network providers. Depending on your insurance plan, staying in the referral circle provides you with a cost benefit and direct access to specialists. 

Can I self-refer? 

  • Before consulting with a specialist, it is important to schedule a visit with your Primary Care Physician (PCP). Your PCP works within a strong network of providers with whom they have established relationships. Seeing providers within this network guarantees high-quality, efficient and coordinated care. 

Can I request a referral after I have already seen a specialist? 

  • Referrals should be requested prior to your specialist visit. If you are seen by a specialist without a valid insurance referral authorization on file, your claim may be denied and you may be held financially responsible for the visit. 

How do I obtain a referral? 

  • In non-emergency situations, the first step in obtaining a referral is contacting your PCP to determine if specialty care is necessary. 
  • If so, you will be referred to a specialist within your Primary Care Physician Referral circle or to another specialist in our referral network. 

What if I want to see a different specialist or already have a specialist affiliated with a different organization? 

  • Our primary goal is to provide the best and most efficient health care available. Seeing specialty providers within your PCP’s network allows for the most complete care.   All questions regarding specialists should be discussed with your PCP. 

What if I am out of my coverage area and need an insurance referral? 

  • Coverage for out-of-area services varies by insurance carrier and plan. It is always best to contact your insurance company prior to receiving non-emergent care.