There has been an extreme change in payment for health care over the past few years. Many of you find yourselves with very new types of health insurance. These plans are often complex, hard to understand, and may have been given to you with very little explanation and instruction. To add to the confusion, many HMO’s offer several different "products," each with somewhat different packages of covered services. And, some plans make periodic changes in the covered services.

This summary has been written with the goal of clarifying some of these issues. We all have the same goals: to ensure that you receive the best health care possible. Our challenge is to accomplish this as smoothly as possible in an environment which is becoming more and more complex.

1. Provide excellent medical care to you.

2. Refer you to a specialist when medically appropriate.

3. Complete a non-urgent referral within 5-7 days.

4. Complete an urgent referral on the same day.

5. Obtain pre-authorization for testing and specialist evaluation when required by your insurance plan.

6. Collect a co-payment from you at the time of your visit.

1. UNDERSTAND THE DETAILS OF YOUR INSURANCE!!

2. Inform us of any change in your insurance (and change of address and/or phone number) before your visit.

3. Bring your insurance card to each visit.

4. Pay your co-payment at the time of each visit.

5. If you anticipate the need for a non-urgent referral, contact our office. One of our doctors will usually need to see you before a referral can be given.

6. Do not call us to say that you already have a new appointment with a specialist on the same day (and need a referral immediately).

1. Our doctors are required by your insurer to evaluate every problem before giving a referral. This can occasionally be done over the phone at the discretion of the doctor.

2. Our doctors have extensive training and experience in many sub-specialties and can effectively treat many problems that specialists also treat (e.g. conjunctivitis, back pain, urinary infections, skin rash, etc.).

3. All referrals have an "expiration date" (usually 2-6 months). If you have seen a specialist, and the specialist recommends a follow-up visit, it is your responsibility to make sure that the referral has not expired before you re-visit the specialist.

4. If you are given a referral to a specialist and you postpone your appointment, it is your responsibility to make sure that your referral is still up to date.

5. If a specialist recommends a test or procedure, very often a separate referral must be issued by our office before the test is done.

6. It is our policy that if a patient sees a specialist without a referral, we will not immediately fax a referral to the specialist’s office (unless there is a medical urgency).

7. Our doctors and staff are very knowledgeable about the specialists and testing facilities in our area. If you choose a specialist, etc. outside of our area, it is your responsibility to provide us with the name, address, phone, and provider number of that specialist.

8. It is usually not possible to "back date" a referral.

9. It is always possible for a patient to see a specialist without a referral if the patient chooses to pay out of pocket for the visit.

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