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Do I need a referral?

Some insurance plans require that a specialist has a referral/authorization on file before you can be seen. Insurance plans that require this require a referral for every visit to a specialist. Your PCP must be the one to initiate the referral. While we make every attempt to facilitate this process for the patient, it is ultimately the patient's responsibility to know the requirements of their insurance (i.e. if the patient is required to have a referral on file for each visit to a specialist) and to have a referral on file at the time of their visit.

If your insurance requires a referral from your Primary Care Physician (PCP) to be on file before a visit to a specialist, please call your PCP and let them know of your appointment and request a referral. Please make sure that we either have it on file before your appointment or that you bring one to the office at the time of your appointment. For many insurances, we are able to print your referral from the insurance portal but you must still initiate the referral by requesting it from your PCP. Some referrals are for one visit only and some are for multiple visits. 

Below is a list of some insurances that require referrals from a PCP before a specialist can see the patient. (Note: This list may not be exhaustive and it is best to check with your insurance and your PCP to see if a referral is required.)

 

Insurances that require Referrals from the Primary Care Physician

AvMed Medicare Choice

BlueCross BlueShield Medicare Advantage

BlueCross BlueShield BMedicare HMO

BlueCross BlueShield My Blue

CarePlus CareNeeds Dade (parts A&B)

CarePlus CareOne Plus Dade

Coventry Medicare

HealthSun Medi Max

HealthSun Sun Plus Dade

Medica Medicare Max

Medica Medicare Max Plus

Molina Medicaid

Neighborhood Health Plans (some plans)

Sanus Health International

Simply Complete Dade

Simply More

Tricare Prime

UnitedHealthcare NHP HMO

UnitedHealthcare Neighborhood HMO Access

United Health Neighborhood (some plans)

UMR Baptist Health Quality Network

WellCare Access HMOs NP

WellCare Dividend HMO POS