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You are here: The Truth about Referrals
The Truth about Referrals
Myth: Your Virginia Pediatric group Primary Care Physician (PCP) or nurse practitioner notifies the Virginia Pediatric group referral coordinator or your insurance company of your need to take your child to a specialist.
Fact: No, the providers do not notify the referral coordinator or your insurance company. We rely on you to provide the information about your referral since frequently the specialist whom you will see or the time of the appointment changes. Please fill out our referral request form so that we have all of the information that we need to process your referral. You can submit this form to us over our web site or you can call our referral hot line (703) 573-2432 Ext 418, to leave the information. Please allow 5 - 7 days for processing.
Myth: Your Virginia Pediatric group PCP or nurse practitioner knows which specialists take your insurance.
Fact: With so many insurance companies, it is impossible for your Virginia Pediatric group PCP or nurse practitioner to know which specialists are approved by your company. Make sure that you ask the specialist's office if that specialist takes your insurance when you set up your appointment. If the specialist does not take your insurance, you may be subject to "out of network" costs.
Myth: You will receive a copy or a phone call, when your referral is processed.
Fact: No, please contact the specialist office 3 business days before your appointment. Your referral will be faxed directly to your specialist office.
Myth: Your referral was processed so you won't be getting bills from the specialist's office.
Fact: Our office can process a referral, but an insurance company can still deny coverage. Each company has different benefits and different plans within that company. What a company covers under your plan is based on your individual or group policy. It is your responsibility to know what coverage your insurance company allows. You may also be responsible for co-payments or deductibles. Call your insurance company to be sure.
Myth: The specialist's office knows you will need a referral and will obtain one for you.
Fact: Again, with so many different insurance companies and plans, it is difficult to know for certain who needs a referral and who does not. In general, if you have an HMO, you will need a referral. On occasion, the specialist's office will call Virginia Pediatric group for a referral, but do not depend on it. You are ultimately responsible and will have to pay for specialist's charges if you do not obtain a referral.
How to request a referral
Referral Bulletin
Managed Care Reform, a law that became effective on January 1, 2001, has changed the referral system in two significant ways.
You no longer need a referral for emergency room services.
Step 1: Verify with your company that you need a referral. Even if your insurance is managed, you may not need a referral for some services. For example, most companies do not require a referral for annual or biannual eye exams, or for laboratory tests. Also, most companies have PPO plans that do not require referrals. So check with your company before you begin the referral process.
Step 2: Speak with your pediatrician or nurse practitioner about the need for a referral and receive medical approval for that referral. Although you no longer need a referral for emergency room visits, it is wise to call first because your pediatrician or nurse practitioner can often expedite your emergency room visit if one is necessary.
Step 3: Make an appointment with the specialist whom your provider has referred you to. When you call the specialist, be sure to ask for the specialist's provider ID number for the type of insurance that you have. At that time, please confirm that the specialist is a member of your health insurance network; otherwise you may be subject to "out of network" costs.
Step 4: Inform our referral coordinator of the information necessary to process your referral paperwork. You can do that through one of the following options
Preferred Method:
- Preferred Method: Click on referral request form at the top of this page. Furnish the information requested and click on submit.
- Call the Virginia Pediatric group referral line at (703) 573-2432 Ext 418, and leave us all information required.
It takes approximately 5 - 7 business days to process your referral. Most referrals are now electronic, so there is no hard copy. Your specialist will receive the referral via fax. If you have questions, please contact our Referral Coordinator at (703) 573-2432 Extn 418.
Referral Request Form
At this point, you should have all the information about your referral in front of you.
Have you verified with your insurance company that you need a referral for the problem that your child has?
If not, please stop here and call your insurance company or read the information about your insurance policy.
Have you received approval from your PCP (pediatrician or nurse practitioner)?
If not, then stop here and call your PCP at Virginia Pediatric group.
Have you made the appointment with the specialist?
If not, stop here and call the specialist's office to make an appointment remembering to allow 5 - 7 business days to process your referral.
If yes, then proceed.
VAPG Referral Request Form
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