Referral Policy

We have over the past several years attempted to modify our referral process to meet the needs of our patients, their insurance carriers, and the various specialty care offices to which we refer. There are over one hundred specialists to whom we routinely refer; each of who has their own office policies. Some of the physicians are particularly respectful of the referral process, judiciously use the referrals we authorize and always reply with their findings in a timely fashion along with their reasons for needing further visits. Others deal exclusively with the patients, reply to the consultation very slowly, do not involve us in any further treatment planning, and make all follow up appointments suggestions exclusively with the patients. This latter policy is unacceptable to us.

A referral to a specialist is a request for their help in determining how to address a specific problem; it is not a transfer of care. We do not expect one referral to an allergist or a dermatologist to translate into our permission to treat the patient for life without every asking again if we the physician still need the specialist's help. If we are not performing well enough in a specific area that you feel that you need repeated visits to a particular specialist even when we feel we can meet your child's needs here, then you need to find a new primary care giver. .

For each referral, you must contact our office at least one week before the referral appointment to give us enough time to review the request and contact you beforehand if necessary. No referral will be authorized if it originates with the family without contacting us first to discuss the problem and no referral will be authorized if we are not given the one week lead time.

Each insurance company has a different policy regarding referrals based on the products they sell you or your employers. In general, there are three major types of coverage: HMO coverage, PPO coverage, and general Indemnity coverage. The HMO coverage is the least expensive and has the tightest restrictions. It is marketed to the subscribers as allowing each patient to the network wide group of physicians. Unfortunately for us, your physicians, we cannot be part of their primary care network unless we agree to accept part of the risk involved in care for you. In simple terms, if the cost of your medical care exceeds the budget the insurance company has set, the physician providers must make up the shortfall. We the physicians end up paying for your referrals. Each of us is ethically bound to provide the single best care we can provide for each patient we care for. We recognize this responsibility and take it very seriously; however, if we are responsible for each referral, we need to be part of each referral request. This may seem onerous and impractical to you, and it certainly is cumbersome for us, but it is absolutely necessary. We have contacted each of our specialist colleagues about this situation. They will require that you have a referral in place before they provide specialty care.

For the other options offered by your insurance carrier, the referral restrictions may be less onerous. For a PPO product, you may not need a referral as long as the specialist is with your plan's network; for an Indemnity product you may not need a referral at all. It is your responsibility ultimately to determine the specific dictates of your plan; as much as we can, we will help you with this responsibility, recognizing that there are a multitude of insurance carriers and products that we have to deal with.