Referrals

Managed Care Referrals

The process of obtaining a "routine" managed care referral to a specialist can be a complicated and time-consuming process for both doctor and office staff, and does not just involve making a single phone call or fax. Minimum information required includes your insurance ID number and date of birth, the insurance provider number of the specialist you want to see, the numerical diagnosis code for the condition for which you are seeing the specialist, and the numerical procedure codes for the services the specialist will provide.

All referrals to specialists, for physical therapy, for diagnostic testing, etc. - whether it is an initial referral or a followup - will require an office visit with co-pay. Your managed care plan considers telephone referrals without an office visit to be a "self-referral," and actually prefers an in-person office visit in order to confirm the medical necessity for any referral.

Please be advised we will not issue any routine, non-emergency referrals without an office visit. We will not authorize "same-day referrals" over the phone if you go to a specialist without first seeing Dr. Finkel, unless there is a documented medical emergency confirmed by the specialist.

In the event you do see a specialist or go for a diagnostic test without the proper referral in advance, you may have to cancel the appointment or pay for the service personally. Retroactive referrals are not permitted except in the event of a documented medical emergency, which may require written confirmation by the specialist who rendered such services, and even then may not be approved.

Please call us - or your insurance plan - if there is any confusion over our office policy, which is also the policy of all managed care plans that require referrals.