What is a referral?
If your child will benefit from seeing a doctor with specialty training or if they need other services, your pediatrician will enter a referral into the electronic health record. This starts a process to request authorization from your health insurance plan and provides information to the specialist about the reason for referral.
This is an expert in one part of the body or one type of illness. Examples are cardiologists and surgeons. Your PCP may also want you to go to a hospital, clinic, or other place for tests like lab work or x-rays. The care given by the specialist and other places is called “specialized care.”
How do I schedule an appointment after getting the referral?
Most referrals take one week to process. In some cases, your pediatrician may ask for a “rush” referral, which will take three (3) days. Once your referral is approved, you might receive notification from a CPCMG referral coordinator or the specialist's staff may reach out to schedule. If your referral is not approved, you will get a letter telling you why.
If you don't hear about the referral within one week, please contact the CPCMG referral staff for assistance.
Please contact your child’s pediatrician office and ask for their referral coordinator contact information.
How long will it take to get an appointment?
The time you must wait before you are seen depends on the availability of the specialist or place and on your need for treatment. If your appointment does not work you can ask the specialist or place for a different day or time. Talk to your PCP if you think you are not being seen soon enough.
Can I find my own specialist or place?
Most of the time your PCP will send you to a specialist or place that he or she already works with. This makes it easier for your PCP and the specialist or place to communicate with each other and get you the care you need. Talk to your doctor before he or she makes the referral if you want to go somewhere else.
Assistance with the referral
What if I need help? You may need help getting an appointment or talking to the specialist in your language. You may think the specialist is too far away. The first thing you should do if you need help is talk to your doctor.