Putnam Valley Pediatrics
REFERRALS MANAGEMENT
Parents: Please Review This Information Carefully Before Requesting a Referral Authorization Below
Your managed-care health insurance company may require a referral each time your child needs to see a specialist, issued before your actual appointment. It is required that you be referred to a specialist who has agreed to participate in your health-care plan, and retains the right to pre-approve or disapprove referrals to specialists who are not participants in their plan. For certain services, written pre-authorization is also required. If these rules are not explicitly complied with, they may refuse to pay for the services, resulting in significant financial expense for your family. Please be fully aware that Putnam Valley Pediatrics can prepare and send in a referral request for your child, but the decision whether to approve or reject the referral, and the services to be provided, is made by your insurance plan.
The staff of Putnam Valley Pediatrics will cooperate with you and your health plan to process appropriate referrals. Since our goal is quality health care for the children in our practice, we will try to refer you to qualified participating specialists as much as possible, but also we will always discuss with you your options in the event there is either no specialist, or no qualified specialist, on the health plan's list.
It is also in your best interest to be an educated consumer. The final decision-making and responsibility for complying with the health-plan's requirements rests with you, the consumer.
If you need additional visits, the specialist must contact the health plan directly with the supporting medical information needed to obtain a new written referral and/or authorization. In the event the specialist wants to provide additional services or tests, he or she must first contact the health-plan directly for pre-approval. In the event the specialist wants to send you for laboratory work or xrays, he or she must supply you with your health plan's approved laboratory or xray request slip, and must refer you to a laboratory or xray facility which participates in your health plan. If the labwork is drawn in the specialist's office, it is their responsibility to make sure it is routed to your health-plan's approved laboratory. All specialists, as part of their participation contract, have been supplied with the appropriate forms, requests, and instructions, and are responsible for helping you comply with your health plan's requirements.
When you mouse-click on the link below, you will access a form which will allow you to submit a referral request on-line to our office. Please fill it out completely before submitting it. Please remember that these requests are reviewed each weekday (M-F only) at 8AM and 1PM, and will take 24 hours to process them. Please also remember that most insurers do not process referrals at night or on weekends -- please make sure you allow us enough time to contact your insurer, submit the application, and get confirmation of their approval or rejection.
It is in your own best interest to be careful and make sure that all your health-plan's rules are adhered to. If you are supplied unapproved services, if you are given an incorrect lab request or sent to a non-participating laboratory, your health plan may have the right to refuse to pay for the services, resulting in significant financial expense for your family.
Enter a Request for a Referral
RETURN TO HOME PAGE