Referring a patient to a specialist:
We need to make sure we have the patients most updated insurance information. Many insurance plans will only authorize consultations with contract providers. After it has been determined that an authorization is required, the medical assistant will submit the appropriate forms and documentation to the insurer. Upon receipt Insurance approval and documentation will be forwarded to the specialist. Insurance approval can take up to 14 days. The specialist will screen the referral for appropriateness clinically. They also must verify that they contract with the insurance company. After this is complete, they will contact you, the patient, directly to make an appointment
2 discusssion
Post 2 Lesson 14 Discussion Board Unit 7
Hello, Mary:)
Great explanation of the steps in referring a patient to a specialist. To add a few points, my primary care physician's nurse contacts my insurance company directly after my PCP wants me to see a particular specialist, verifying the specialist is covered and part of my network or plan. One time the recommended specialist was not part of my network and the PCP nurse contacted me letting me know. I decided to go ahead and go to the recommended specialist, but knew my insurance would not pay as much as an in-network provider. My PCP faxed my medical records to the specialist and they contacted me to set the appointment. Because the specialist was out-of-network, they required me to pay up front the difference.
Hope you have a great week!
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