DMV Allergy & Asthma Center – Allergist Washington DC & Alexandria
Do I need a referral to see a specialist?
Certain insurance carriers require that a patient’s primary care provider (PCP) submit a referral to the patient’s insurance carrier in order for the patient to be seen by a specialist.
The providers at DMV Allergy and Asthma Center are considered specialists. It is the patient’s responsibility to inquire with his or her insurance carrier to see if a referral is required. If so, it is also the patient’s responsibility to coordinate with the PCP to have the referral submitted to the insurance carrier and confirm with the carrier that the referral is on file with the carrier prior to his or her scheduled appointment at AAC.
Certain insurance carriers (including various United HealthCare products) require that the referral be electronically submitted by your PCP and will not accept paper referrals. Again, it is the patient’s responsibility to contact his or her insurance carrier and PCP to meet these requirements. Common carriers that require referrals include United HealthCare HMO’s, Aetna HMO’s, BCBS HMO’s, and others with such stipulations in the patient’s member handbook.
Additionally, some insurance carriers require that referrals be renewed after a certain number of visits and it is likewise the patient’s responsibility to contact the carrier and PCP to ensure that updated referrals are on file.
The insurance carrier may deny services or process the services with a higher patient liability if a required referral is not on file; the patient is responsible for any balances that result from lack of referral.