Referrals Facts
The Truth about Referrals
Myth: Your Centre Pediatrics Primary Care Physician (PCP) or nurse practitioner notifies the Centre Pediatrics referral coordinator or your insurance company of your need to take your child to a specialist.
Fact: No, the providers do not notify the referral coordinator or your insurance company. We rely on you to provide the information about your referral since frequently the specialist whom you will see or the time of the appointment changes. Please fill out our referral request form so that we have all of the information that we need to process your referral. You can submit this form to us over our web site or you can call our referral line (617) 277-7337, option 1, to leave us your fax number or address so that we can fax or mail the form to you. You can also pick up the form in our office.
Myth: Your Centre Pediatrics PCP or nurse practitioner knows which specialists take your insurance.
Fact: With so many insurance companies, it is impossible for your Centre Pediatrics PCP or nurse practitioner to know which specialists are approved by your company. Make sure that you ask the specialist's office if that specialist takes your insurance when you set up your appointment. If the specialist does not take your insurance, you may be subject to "out of network" costs.
Myth: If you haven't received a copy, your referral hasn't been processed.
Fact: Most referrals are now electronic via a machine called a POS devise or via the telephone. Therefore, there are no hard copies. Your specialist should be able to access the information via the POS devise or the telephone. Some referrals are done verbally and you or your specialist will be called with the referral number.
Myth: Your referral was processed so you won't be getting bills from the specialist's office.
Fact: Our office can process a referral, but an insurance company can still deny coverage. Each company has different benefits and different plans within that company. What a company covers under your plan is based on your individual or group policy. It is your responsibility to know what coverage your insurance company allows. You may also be responsible for co-payments or deductibles. Call your insurance company to be sure.
Myth: The specialist's office knows you will need a referral and will obtain one for you.
Fact: Again, with so many different insurance companies and plans, it is difficult to know for certain who needs a referral and who does not. In general, if you have an HMO, you will need a referral. On occasion, the specialist's office will call Centre Pediatrics for a referral, but do not depend on it. You are ultimately responsible and will have to pay for specialist's charges if you do not obtain a referral.
