An important aspect of having a managed care health plan or HMO Insurance is having your primary care physician assess your health care needs. This step helps your provider to clarify your medical record to properly diagnose the problem and to give you a better chance of being referred to the most appropriate specialty physician.
**If you seek the services of a specialist without a prior authorized referral, you may be held financially responsible for the entire specialty service.**
Our Referral Specialists can assist with the HMO Referral Process. You can contact the office and request a referral authorization prior to any specialty service being rendered. If your insurance requires we process a referral, we must document the required criteria before processing the referral. If the criteria is met, the referral authorization must be requested and received prior to your specialist visit. It is the patient’s responsibility to become familiar with their insurance policy and its requirements for obtaining referrals.
So that we may accommodate your requests and needs in a professionally efficient and timely matter we ask that you familiarize yourself with Mount Vernon Internal Medicine’s Referral Policy below. If you have any questions regarding the policy, please ask for clarification.
Mount Vernon Internal Medicine Referral Policy
– A minimum of 5-10 business daysis needed for this office to process non-emergency referral requests.
– Emergency referrals will be handled as quickly as possible.
– It is the patient’s responsibility to make sure that they have complied with the referral policy guidelines of our office and have met the requirements mandated by their health plan. The patient must have an approved and completed referral form or authorization number in hand PRIOR to examination by a specialist or testing performed.
– Retroactive Referrals WILL NOT be issued. If you are seen by a specialist or facility without the proper referral, your insurance carrier will most likely deny coverage and you will be responsible for charges incurred. If you receive treatment in a hospital emergency room or urgent care facility during a weekend, holiday or after hours, you must report this to our office on the first business day following treatment, so we can provide proper authorization to that facility.
– If a specialist refers you to another physician or facility you must contact our office for that referral.
How to Obtain a Referral:
- Select a specialist – contact your insurance carrier for an In-Network provider listing or ask our staff for a list of recommended specialists in the area to compare.
- Call the specialist’s office and make an appointment (be sure you give yourself at least 48 hours before the appointment so you can obtain a referral) – verify that the specialist is PARTICIPATING with your insurance plan.
- IMMEDIATELY call our office at (703) 780-2800 and select the option for the referrals. If it goes to voicemail please speaking slowly and clearly, and leave the following information:
– Your full name (spelling out your last name) and date of birth.
– A phone number where you can be reached or where a message can be left.
– Name and phone number of the specialist you will be seeing (please give the address if you have it available).
– The reason for your visit to the specialist, the date and time of your appointment.
– Please state whether you will be picking up the referral from the front desk or if you prefer it mailed to your home.
Specialist Follow-Up Referral Requests
In order to ensure the processing for a referral plan authorization, we request that you contact the office at minimum of 5-10 business days ahead of any scheduled appointments. If the Referrals Specialist does not have enough notice, they will not be able to process same-day referrals requests. Therefore, you may be required to reschedule your specialty care appointment or be held financially responsible.