Frequently Asked Questions About Referrals

What is a referral?

A referral is an authorization from the patient’s Primary Care Physician (PCP) for the patient to visit a specialist.  A PCP can be a family doctor, internist, or pediatrician.

How do I know if I need a referral?  Do I need a referral to see an ENT specialist?

You need a referral only if your insurance company requires you to have one.  Typically HMO plans require a referral, however the best way to know for sure is to contact your insurance company before you make an appointment with a specialist.  The phone number is located on the back of your insurance card.  Some insurance cards state on the card whether or not you need a referral.

How do I get a referral?

If you are at your PCP’s office and they are referring you to see us, be sure to get the referral coordinators name so you can obtain your referral.  Otherwise you would need to contact your PCP and tell them that you need a referral for your visit.

How does my referral get from my PCP to the ENT specialist’s office?

You can have your PCP fax your referral directly to us at (855) 388-5350, but the best way to ensure we get your referral is to obtain it from your PCP’s office and bring it with you to your appointment. That way you eliminate the chance of it not being here when you arrive.

What happens if I don’t have a referral the day of my appointment?

Unfortunately, if your insurance company requires a referral and you do not have one, they will not pay the claim for your visit and the patient or patient’s parents will be responsible for the bill.  Therefore, we cannot see the patient without a referral, unless they sign a referral waiver and agree to pay in full at the time of service.

Do I have to get a referral every time I come see a specialist?

Every referral has an expiration date and number of allowed visits.  If you need to come back to the specialist after the expiration date or for more than the specified number of visits, you will need another referral from your PCP.  For example, the referral may be good for one year but only allows two visits; therefore, if you need to see the specialist for a third visit, you will need another referral.