Referrals

Referrals for Specialist Providers in Mill Creek and Elkins, WV

Referrals for specialist health care providers are required by most insurance providers. A referral is a written order that you obtain from your primary care physician. The referral will state which specialist you are being referred to, and what specific service is to be provided. Depending on your medical condition, additional information, lab tests, medical reports, etc. may also be provided along with your referral to help ensure continuity of care. Referrals may be required for providers within the Valley Health Care system, as well as independent providers.

Why Do I Need a Referral?

Aside from being a requirement for payment by most health and medical insurance companies, referrals help ensure that you are receiving the most appropriate care from the optimal medical provider for your condition. Although referrals are not always required, it is still a wise decision to visit your primary care physician if you are experiencing a new condition or symptoms. He or she has access to your complete health record and is best able to assist you with accessing the ideal care for your illness or injury. Please note that if you self-refer to a specialist, any insurance coverage that you have may not actually cover the fees for the service or office visit. You may be personally responsible for 100% of any amount due. If you have any questions, please contact our office.

How Does the Referral Process Work?

Our staff requests that you bring your most recent insurance card to each visit. We will review your insurance provider’s guidelines to determine whether a prior authorization is required, and if so, what the procedure is. If a referral is required for you to see a specialist, we will prepare the paperwork to request the authorization and submit it on your behalf. Please note that some insurance plans require that you select a specialist who is a contracted provider with the insurance provider. Please allow approximately 48-72 hours for an authorization or denial. In some cases, two to three weeks may be required when dealing with certain insurers. The specialist may also screen referrals for appropriateness. Valley Health Care or the specialist will contact you directly following approval to schedule your appointment. If there is any question regarding whether or not the referral has been approved, please contact your insurance provider directly for verification.