POLICY REGARDING REFERRALS / HIGH-DEDUCTIBLE INSURANCE PLANS

January 1, 2012

HMO PLANS AND PATIENTS REQUIRING PRIMARY DOCTOR REFERRALS

New patients and returning patients who need an insurance referral MUST arrive for their appointment with a referral. Per medical insurance regulations, without a referral the patient CANNOT be seen, and the appointment must be rescheduled.

PATIENTS WITH HIGH-DEDUCTIBLE INSURANCE PLANS

• New patients must pay $175 toward their deductible before they can be seen for their appointment.
• Returning patients must pay $50 toward their deductible before they can be seen for their appointment.
• If the full deductible amount has been met, proof will need to be provided

MEDICATIONS NOT COVERED BY YOUR INSURANCE / NOT ON YOUR MEDICATION FORMULARY

Medical insurance companies frequently change the medications on their formularies that are covered/paid for by the insurance company. If a medication is not on the formulary, you are responsible for paying a higher co-pay, or for the full cost of the medication. Your insurance will not cover non-formulary medications unless the medications that are covered under your plan are tried and failed.

If a medication that you require is not covered by your insurance, a Medication Prior Authorization Form needs to be submitted to your insurance company. In order to help us expedite this process, please click on the link below, complete the form, and return it to our office (drop off, mail, fax).

Submitting a prior authorization request does not guarantee coverage of the medication.

Click here for Medication Prior Authorization Request form