A referral is an order from a medical professional for a patient to see a specialist or receive certain medical services, usually sent with documentation to support the requested services.
Referrals are required by most health insurance companies to ensure that patients are seeing the correct providers for problems that have been deemed medically necessary. Failure to obtain the necessary referral before seeking specialty care can result in coverage being denied by insurance, and costs being passed on directly to the patient.
Your need for a referral depends on what type of health plan/coverage you have.
- Medicaid coverage – Your Primary Care Provider would determine your need for a referral.
- VA/Tricare – ALL services require a referral from a primary care provider
- Private insurance – Your need for a referral would be determined by your health plan and your Primary Care Provider.
In summary, Referrals typically apply when a patient is seeking specialty medical treatment; however, each insurance plan is different, with some requiring a referral before receiving treatment from anyone except your primary care doctor. If you’re not sure, contact your insurance or your primary care doctor to clarify. This will help prevent unexpected or out of network costs in future.
To learn more about SEARHC’s standard charges for services, visit our Price Transparency page.
The services needed and your health plan/coverage may determine your ability to self- refer. It is best to contact your Primary Care Provider to verify.
Use the Location Lookup Tool to find your current clinic contact information, or search for a new service provider in your community. Find locations that offer specific services, or use the map view to explore options close to you.
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- If a provider has told you a referral will be made and you have not heard anything within the last two weeks, please call your primary care provider to check on the status of your referral.
- If you have been assured that your provider has submitted a referral to SEARHC, please contact the service line you have been referred to at the number listed on that service page.
To submit a referral, please fill out this form.
To make an appointment as a first time SEARHC patient, please request an appointment here.
To make a primary care appointment as an existing SEARHC patient, please contact your local clinic.