Policy

There are times patients would prefer to see a specialist without seeing their primary care doctor. Since we can not evaluate medical problems over the phone we prefer to see you in our office for problems to determine if they can be treated in our office. If it requires a referral, we need to identify the underlying condition and refer you to the correct physician. Also, many insurance companies require the primary care doctor to evaluate the problem before a referral can be made. We also ask that you have the specialist communicate to us after seeing you. Some insurance plans require a letter from the specialist to the family doctor. Seeing you beforehand and receiving information back from the specialist facilitates continuity and quality medical care. Please notify us of your appointment, the doctor's name and fax number and we can then provide any pertinent information concerning your care to that doctor. Please ask the specialist to send us a letter regarding his/her ideas or suggestions.

If you need testing or a referral to a specialist, always check your insurance policy to see if the test requires precrtification or the doctor, a referral. If necessary, notify our Referral Department at least one week in advance of any appointments you have to see specialists or receive testing. This allows us time to complete a referral for you should one be required. If we are not notified you may end up financially responsible for those services. Calling us the day of your appointment could result in your having to delay your appointments until your insurance company's requirements are satisfied. This office is prohibited from issuing retroactive referrals. We are not permitted by your insurance company to write a referral for a specialist visit after that visit has occurred.

Please refer to your Insurance Handbook to determine what needs a referral or pre-certification and what doesn't.

If you have Medicare you do not need a referral to see a specialist, unless your secondary insurance requires one.

Summa does NOT require referrals, as long as you are going to an in-network specialist. Check your Summa Provider Directory or online at www.summahealth.org

Aetna HMO and EPO plans require referrals.

Medical Mutual Super Med Plus, Classic and Traditional Plans do NOT require referrals.