![]() ![]() What are the restrictions or limitations to my coverage? (For example: dollar amount per year or number of visits per year)īy talking to your insurance company directly, you reduce the chance of having unexpected expenses and can help the referral process from our office.What is my co-payment for each visit, or what is the percentage of coverage?.In what month does your policy year begin?.Do I have a deductible for these services? If yes, how much is it and how much has been met so far?.Helpful financial information for you (if needed): This may also be called an “authorization.”) Is pre-certification necessary? ( Note: Vocabulary changes across carriers.If not, who is considered in-network? What are my out-of-network benefits?.Is (doctor/therapist name) currently a network provider for my plan.Call reference number (if available): _.Specialty and name of desired provider and their location.*Ĭall the member number on your insurance card and tell them that you “need to verify outpatient/specialist health benefits” or “see if a provider is in-network.”Make sure you have the following information at hand for the call: * It is the patient/parent’s responsibility to confirm that specialty providers are in network with their insurance, as well as to request a prior authorization/referral be processed by the PCP (GROW) if their insurance plan requires this. Contact your insurance carrier for verification of benefits and/or if pre-certification of services is required. Some insurance policies require pre-authorization for services. Does your insurance require precertification?.When will you be seen? (if you already made an appointment).Provider’s office/facility name and location.If that is the case, let us know and we will process their request right away.įor assistance or inquiries regarding referrals, please call our office and leave a message for our referral coordinator. Some offices may not let you make an appointment until they receive a referral from the primary care provider.If the specialist requires this, they routinely contact GROW by phone or fax and we provide what they need. Clinical documentation, diagnostic imaging, and lab reports may need to be sent for the specialists’ knowledge prior to your appointment or as support for insurance claims.See the next section (“Insurance Referrals”) if you are unsure if you need a precertification or need help finding out if a provider is in‐network.Your insurance may require precertification.The Member Services department of your insurance carrier can also suggest specialists in your area that are in your insurance network. Otherwise, you may reference the helpful resources below to find a specialist. Your PCP at GROW may recommend a specific provider or specialty facility. The next step is for you to contact your preferred specialty provider and schedule an appointment. Oftentimes, a visit with your child’s primary care physician can result in a referral to a specialist for various reasons. Saturday Sunday Monday 6:30 pm – 10:30 pm Schedule online via M圜hart, or call 51.Īfter Hours Kids at Pediatric Associates of Austin: Several locations available during regular business hours.
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