» Patient Information

Managed Care Statement

Patients Primary Care

 

  1. Prior to your initial visit, please make sure that you have notified your insurance carrier of your selected primary care physician. If we are not the primary care physician of record, we can not see you. We will ask you to reschedule for a date after which you have contacted your insurance carrier and properly designated us as the primary care physician.
  2. If you require a referral to see a specialist physician, you must be seen by your primary care physician first.
  3. Referrals will be processed and available to you seven business days after they are requested or after the primary care physician recommends a specialist’s evaluation. Referrals will only be issued sooner if the primary care physician determines that the specialty evaluation is a medical emergency.
  4. Referrals may be picked up at the primary care physician’s office or, with special arrangements, faxed to the specialist or mailed to the specialist or patient.
  5. Medical records are generally required for specialty evaluation. Your records may be faxed or mailed to the specialist or you may be asked to pick up these records to bring with you to the specialist.
  6. Most referrals are issued for a limited number of visits and will have an expiration date. Follow-up visits with your primary care physician are usually required before additional referrals are issued.

 

Specialist Consultation and Follow-up Care

 

  1. If your health insurance requires a referral, we must have that referral prior to or at the time of your visit. You are responsible to determine if a referral is required and to arrange for that referral to be issued and delivered.
  2. If the referral is incomplete, incorrect or not in our possession at the time of your appointment, we cannot see you at that time. We will ask you to reschedule your appointment for a date after which you have secured the proper referral.
  3. Many patients have more than one insurance policy. You must obtain a referral for every policy that may require one. For example, if you are covered by traditional Medicare, which does not require a referral, as your primary insurance but have a supplemental policy as secondary coverage (“Medigap”), which does require referrals, you must obtain a referral for your secondary coverage prior to your visit even though your primary insurance does not require a referral. Referrals from secondary carriers cannot be obtained after a claim has been submitted to your primary carrier.
  4. Every referral identifies the level of medical service requested. Please make sure that the referral is written for service codes 99499 or 99245 and 99214. If other service codes are used, they may not be sufficient for a complete consultation with proper follow-up care and you will be asked to reschedule for a date after which the referral is amended and received with proper codes of service.
  5. Most referrals are issued for a limited number of visits and have an expiration date. You must monitor the number of remaining visits and obtain a new referral from you primary care physician before the existing referral expires.
Medical Diagnostic Associates Doctors Medical Specialties