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Precertifications / Referrals
Precertification or Prior Authorization
Many health insurance plans have precertification or prior authorization requirements for specific services. Information about these requirements is usually listed on the back of your health care insurance card. Please refer to your card, your benefits hand book or contact the customer service section of your health plan to inquire about your responsibility to complete these requirements.
Managed Care Health Insurance Plans:
A kind of insurance that pays for your health care needs, and also provides your health care within the Plan’s selected network of providers. Most Managed Care Health Plans require members to choose a Primary Care Physician (PCP), and obtain referrals from their PCP to see a Specialist.
What is a PCP?
A Primary Care Physician is a doctor who will provide and coordinate all of your medical care. PCP’s have specialties in:
- General Internal Medicine
- Family Practice/General Practice
- Pediatrics
What is a Referral?
A referral is permission from your physician to seek care. Things to remember about a referral:
- Be certain the referral is for a service covered by your Health Plan.
- The referral should be to a Provider within your Health Plan’s network.
- Check for limitations on the referral. Such as, number of visits allowed, or expiration date.
Remember; contact your physicians about a referral PRIOR to your appointment.
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