Insurance Referral Example

Insurance Referrals

Doctor's Referral

A doctor refers a patient to a specialist or another physician who can take care of a condition.

Insurance Referral

The primary care is submitting a request to the patient's insurance to cover a visit(s) to a specialist for a condition.

An insurance referral allows the insurance to process and pay for the visit to the specialist. If an insurance referral isn't completed (regardless of whether a doctor's referral was done), then the visit will not be covered by insurance. Not all insurances require an insurance referral. The following require insurance referrals:

Most HMOs
A few PPOs

Unfortunately, the requirements are changing year-to-year (sometimes sooner), so we're not able to provide an adequate list of all insurances requiring referrals. The best option to avoid having to reschedule is to call your insurance prior to the visit to ensure a referral isn't required.

Insurance referrals are required to have start and end dates, as well as the number of allotted visits.

Example of an Insurance Referral