Do I Need a Referral or Authorization?
Requirements vary depending on your insurance coverage.
If you are part of an HMO medical group, you will generally need an authorization before seeing a specialist. Some patients may need to contact their primary care physician or medical group to obtain the authorization before their appointment.
If you are unsure what your plan requires, contact your insurance carrier, primary care physician, medical group, or our office before your visit.
Referral and Authorization Are Not the Same Thing
A referral and an insurance authorization are not always the same thing.
A physician or hospital may recommend that you see an orthopaedic specialist, but that recommendation does not necessarily mean your insurance requirements have been completed.
Your insurance plan or medical group may still require a separate authorization before you can be seen.
I Was Referred by a Hospital. Do I Still Need an Authorization?
Possibly.
A referral from a hospital is not a valid insurance authorization. If your insurance plan requires authorization to see a specialist, you may still need to contact your primary care physician or medical group to obtain one.
If you are unsure, please check before your appointment so your visit is not delayed.
If My Authorization Has Been Approved, What Should I Do?
If your medical group has approved an authorization, please make sure the authorization information is provided to our office.
Having this information available before your appointment can help our staff confirm what is needed for your visit.
What If I Am Not Sure Whether My Authorization Is Complete?
If you are unsure whether an authorization has been approved or whether our office has received it, please call before your appointment.
Have your insurance information available so our staff can review the information available to the office and help you understand what may still be needed.
For questions about your insurance plan’s specific authorization requirements, you may also need to contact your insurance carrier, primary care physician, or medical group.
What Information Should I Have When I Call?
Please have your insurance information and basic demographic information available.
If your medical group has already approved an authorization, have that information available as well.
If you have already had an X ray, MRI, or other imaging related to your current problem, let our staff know where it was performed. Bringing previous imaging to your appointment when possible can help make your visit more efficient.
Does an Authorization Mean Everything Will Be Covered?
No. An authorization does not necessarily mean that your insurance will cover the full cost of your visit, imaging, treatment, or procedure.
Coverage and patient responsibility depend on your individual insurance plan. This may include your deductible, copay, coinsurance, network status, and other plan requirements.
For questions about your individual benefits and expected costs, contact your insurance carrier.
Before Your Appointment
Before coming to your appointment, make sure you have completed any referral or authorization requirements that apply to your insurance plan.
If you are unsure, checking before your visit can help prevent unnecessary delays.
You should also bring your insurance card and any authorization information with you to your appointment.
Still Not Sure What You Need?
Insurance requirements can be confusing. If you are not sure whether you need a referral or authorization, call our office with your insurance information.
Our staff can help with the information available to the office and let you know if additional information may be needed. For requirements specific to your insurance benefits or medical group, you may also need to contact your insurance carrier, primary care physician, or medical group.