Insurance and Referral Guidelines

Insurance and Managed Care

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Referrals

If you need specialty care, your Primary Care Provider (PCP) will refer you to a specialist or hospital within the CareGroup Healthcare System that best meets your needs. If the specialist suggests that you see another specialist, please contact your PCP, who will arrange for any additional referrals.

Many HMOs require that referrals be approved prior to any scheduled appointment with a specialist. Without a referral, your health care insurer could refuse to pay the specialist's bill, and you could be held responsible for the cost of the office visit.

When you need a referral, please note:

• Call our referral coordinators through the main office number (617-754-9600) and select the "Managed Care Referral" option.
• Referrals are processed Monday through Friday during regular office hours.
• It is best to contact us as soon as you have an appointment.
• Please allow 5 business days to process routine referral requests.
• Carefully complete your referral information so we can promptly process your request.
• Referrals are limited to a certain number of visits and/or may only be valid for a specific length of time. If you have follow-up visits scheduled with a specialist, please check before your appointment to confirm that your current referral will cover these visits.

If you change insurance plans…

If you change insurance plans, please be sure that the correct Primary Care Physician (PCP) is listed with the new plan. Bring your most current insurance card to your next appointment. If you have already processed a referral for a future appointment while covered under your old plan, please call our managed care coordinator to arrange an updated referral.