Referrals
If you’re wondering how referrals work, we are here to explain all you need to know.
Referral to a Specialist
Occasionally, your doctor may need to refer you to a physician specialist, a hospital, or other medical service provider for treatment. The following tips will help your referral go as smoothly as possible.
How to Cancel or Reschedule Your Appointment
If you need to cancel and reschedule your appointment, please call the specialist’s office at least 24 hours prior to your original appointment. Please keep in mind that specialty referrals that require authorization from your health plan are usually good for only 90 days. If you do not see the specialist within that time, the authorization will need to be resubmitted, which will delay your visit to the specialist.
Routine Referral
Most health plans require authorization prior to seeing a specialist. Please allow one to two business days for your request to be processed for approval. This time is often needed to verify your health plan’s referral requirements. Your appointment should be scheduled within 14 days.
Urgent Referral
Most health plans require prior authorization for urgent referrals to a specialist, but are authorized within 24 hours. If you feel your medical condition is getting worse, please go to the emergency room.
Direct Referral
A direct referral occurs when your insurance does not require a prior authorization. Your appointment should be scheduled within 30 days.
Preparing for Your Appointment
DAP Health’s referral care coordinator will contact you when your insurance coverage has been verified and the authorization is received from your health plan. You will then be provided with the specialist’s office information so you may schedule your appointment. Honoring your appointment time is important.
You Can Help Us by Taking a Few Simple Steps to Prepare for Your Visit
- Please make sure you give our staff your current phone number and address before leaving our clinic.
- Please bring a list of the medications you take to your appointment, including the strength of the medicine and how often you take it.
- Please bring your insurance card, and inform us immediately if your insurance has changed.
- Please be prepared to pay your co-pay (if required) or any services not covered by your health plan, and arrive 15 minutes before your scheduled appointment time to complete any paperwork required.
Non-Compliance
As your primary care physician, DAP Health has the responsibility of assisting you with the coordination of your specialty referral. It is your responsibility to follow through with your appointment schedule. If you have challenges that are a barrier to care, to the best of our ability, we will be happy to assist you in eliminating those barriers.
If you do not comply with your appointment and we don’t hear back from you, we will attempt to contact you via phone, email, MyChart, and/or regular mail. However, if we are unsuccessful, we will send you a letter to terminate our responsibility of coordinating your referral.
Correspondence
We will send you notification via letter once your referral has been approved (if prior authorization is required). If you have missed your appointment, we may also attempt to contact you in order to reschedule. If you have not heard from our office within 30 days of submitting your referral, please feel free to contact DAP Health’s referral care coordinator at (760) 281-8444.
Patient Instructions
Our office may be able to provide you with some basic instructions for some of the most common diagnostic procedures.
Insurance Denials
Should the insurance company deny your referral, DAP Health’s referral care coordinator will review your case with your provider to suggest an alternate care plan. You will be notified of such plan should this occur.