Some insurance carriers require that a patient obtain a referral from their primary care physician in order for the insurance to pay, or pay in full, for care by a specialist physician. Most insurance carriers do not require a referral, but if yours does it is your responsibility to ensure that the referral is in effect prior to visiting our office.
Some of the insurance carriers that require referrals, such as Secure Horizons, will not pay at all if the patient does not have a referral. Others, such as Regence Selections, will pay for our services but will pay at a lesser level if you do not have a referral.
How do I get a referral?
To get a referral you must contact your primary care physician’s office. They will submit a referral request to your insurance. This does not mean that you now have an approved referral. Your insurance company must first process your referral.
You cannot assume that your referral has been approved unless you have received confirmation from your insurance company. If you are not sure if your referral has been approved, please contact your insurance company. Often, you can find out if a referral has been approvedon your insurance carrier’s website.
My primary care doctor gave me a referral form when I was in their office. Isn’t that an approved referral?
No. If you have an insurance that requires a referral, then what you received in the doctor’s office was just a referral request. Your PCP must now submit that to the insurance company and the insurance company must process it. The insurance company will then usually send you a copy of an approved referral. If your insurance does not require a referral, then the paper you received from your PCP is not required paperwork but rather just a recommendation that you should see us for your foot problem.
What happens if I don’t have confirmation of an approved referral when I get to your office?
If your insurance requires a referral and you don’t have an approved referral from the insurance carrier (a referral request from your doctor’s office is not an approved referral) we will still be happy to see you at your appointed time. In this situation, a $100.00 deposit is required prior to seeing Dr. Huppin or Dr. Hale. Payment in full for x-rays or supplies will be due at the end of your appointment.
If I don’t have an approved referral but later the visit is approved, will the deposit be refunded?
Absolutely. Once we receive appropriate insurance documentation, your insurance company will be billed and you will be promptly refunded once your insurance company pays for your services.
How can I find out if my referral has been approved?
Contact your insurance carrier to determine if your referral has been approved.
How many times can I see the doctor on one referral?
It depends – sometimes only once and sometimes several visits are approved. This information can be found on the approved referral from your insurance company. It is the patient’s responsibility to get a new referral if a referral has expired.
We are required to have a copy of your insurance card on file in order to bill your insurance for you. If we do not have this information on file, you are solely responsible for all charges. A $100 deposit is required prior to seeing the doctor and payment in full is due before you leave the office. Once we receive appropriate insurance documentation, your insurance company will be billed and you will be refunded once your insurance company pays.