Referral Request Form

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Click on the following link to access our Referral Request Form:Referral Request Form
 

Referral Policy

Due to the large volume of referrals required by many of the Managed Care HMO’s our office participates with, the following policy has been instituted to reduce error and promote the continuity of your health care:

     

  1. All requests for referral require a minimum of twenty-four (24) hours notice either by telephone or by written request.  It is advisable to arrange for follow up referrals from your primary care physician as soon as you are aware the specialist needs to see you again.  In most instances, this gives anywhere from 3 days to two weeks time to give our office notice of follow up visit, thereby giving adequate time to accurately authorize and prepare your referral.
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  1. This office will issue no back dated referrals. It is the patient’s responsibility to obtain a referral prior to receiving services by a specialist.  Most referrals are given for one visit and therefore additional referrals must be obtained if follow up care is necessary.

 

  1. If a physician from this office wants you to see a specialist, please contact our office within the next few days and ask to speak with our referral coordinator.  In most instances, the physician has already supplied the necessary information internally, however, this practice will eliminate error, confusion and the unnecessary cost of visits not covered by a referral. Many referrals require pre-authorization, that is an additional phone call to the insurance company for medical necessity review. For this reason, it is in your best interest to contact the office as soon as possible so there is no delay in obtaining the necessary authorization.
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  1. Check with your managed care company or review your member handbook to familiarize yourself with your benefit plan. It is always in your best interest to be fully cognizant of your benefits as this will enable you to protect yourself financially as well as medically.

 
IF YOU HAVE ANY QUESTIONS REGARDING YOUR MANAGED CARE COMPANY, PLEASE contact us at 201-288-6781.  WE WILL BE HAPPY TO ASSIST IN ANY WAY POSSIBLE. YOUR COOPERATION IS GREATLY APPRECIATED.

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