What Is a Referral and Why Do I Need One?

Referrals are an important part of an HMO plan because they help your doctor keep track of the care you receive and ensure that the care is right for you.

When you join an HMO plan, you select a doctor to be your Primary Care Physician (PCP). Your PCP will provide your routine care, preventive care, and treatment for common illnesses. Your PCP is also responsible for coordinating or overseeing your care.

An important part of coordinating your care is when your PCP “refers” you to a specialist for services he/she isn’t able to provide. Your PCP works with a team of specialists in a variety of areas who are considered, by your PCP, to be excellent doctors in their respective fields. When your PCP refers you to a specialist, he/she is recommending you see a doctor whose opinion your PCP trusts and who your PCP feels is qualified to diagnose your specific condition. Your PCP and the specialist will communicate to ensure you receive the care you need.

Having one doctor who oversees all of the care you receive is one of the many advantages of being a member of an HMO plan. The intent of coordinated care and our HMO plan is simple; one team working together to help you stay healthy.

Helpful Things To Know About Referrals

You Do Not Need An Actual Referral Slip

When your PCP issues a referral to see a specialist, he/she will send the specialist the referral information. If for any reason, you arrive at your specialist appointment after receiving a referral confirmation from your PCP and are told your referral is not there, ask the specialist’s office to contact your PCP’s office to send the referral while you wait.

Always Check With Your PCP Before Seeing A Specialist

Sometimes a specialist will recommend you see another specialist. Always check with your PCP before seeing a specialist because your PCP needs to issue the referral. A specialist isn’t able to refer you to another specialist. By issuing all the referrals, your

PCP is able to oversee the care you receive and help you see the specialist that is right for you.

Your PCP has a team of specialists called a “referral circle.”

Your doctor’s referral circle includes designated specialists, hospitals, skilled nursing facilities, durable medical equipment providers, and other selected providers. Your PCP’s referral circle represents the specialists and facilities your PCP has selected to work with in his/her area.

The Value Of The Referral Process To You

  1. One doctor (your PCP) oversees your care and collaborates with a team of specialists to help you get the care you need
  2. Your PCP knows your medical history and will be involved in coordinating all aspects of your care
  3. Your PCP will refer you to the specialist within his/her referral circle who will best meet your needs
  4. Your PCP will communicate with your specialist to ensure you receive the care that is right for you

The Referral Process In 3 Easy Steps

Step One: Discuss your medical condition or concerns with your PCP. Your PCP may consult with his/her medical group on the best course of action.

Step Two: Your PCP refers you to a specialist in his/her referral circle and sends your referral information to the specialist.

Step Three: Call the specialist’s office to make an appointment.

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