Managed Health Care and Referrals
The vast majority of our patients are covered by a managed care insurance plan. It is your responsibility to know the rules of your policy regarding emergency room utilization, the use of specialists, and the need for referrals from our office.
Managed Care Referral Process – Obtaining a referral is not just a matter of completing a written document. It includes first obtaining authorization from your insurance company for the particular specialist or procedure. Referral authorization, except in a medical emergency situation, takes a minimum of 5 business days, sometimes longer depending on the service being requested.
A representative from our Referral Department is in our Sand Hill office, available Monday through Friday, 7:30 am – 4:00 pm. This individual is an expert at obtaining the appropriate authorization from your managed care insurance company. Please call with any questions you have concerning your referral.
In order to ensure the referral is completed appropriately and authorized by your insurance company, please abide by the following guidelines:
- Check your benefits - When your child’s pediatrician refers you to a specialist for a consultation or to another facility for testing, please check your benefits by calling the 800 member services number on your insurance card. Ask if the service is a covered benefit under your plan and check to see if the specialist or facility is a participating provider.
- Schedule your child’s appointment – After confirming the above, schedule your appointment with the specialist or testing facility. You should allow 5 business days for the referral department to process your referral before the date of your appointment. Once you have obtained your appointment with the specialist or testing facility, contact our referral department.
- Call Hunterdon Pediatrics Referral Department at 908-782-6700, prompt “3” to process your referral. (Your referral will not be processed until you contact our referral department.)
Please have the following information available for the Managed Care Specialist: - Obtain additional referrals – Future follow-up referrals to the same specialist, if necessary, can be obtained by calling the Referral Department at 908-782-6700, prompt “3.
a. Name of specialist or facility
b. NPI #
c. Phone and Fax #’s
d. Appointment date and time
e. We fax referrals directly to your appointment facility. If you would like a copy, one can be mailed home upon request.
- Check status – If you do not receive a phone call from our Referral Department within 5 business days, please call any of our Managed Care Specialists at 908-782-6700, prompt “3” and state that you are calling to learn the status of your referral request.
- Obtain additional referrals – Future follow-up referrals to the same specialist, if necessary, can be obtained by calling the Referral Department at 908-782-6700, prompt “3.”