Tips from Paula: Who is Responsible for Obtaining Referral Extensions

Over the years, patients on HMO plans have learned the importance of obtaining referrals. What we need to remember, however, is that referrals are often written for a certain number of visits, or for a specific time frame. For example, a PCP may write a referral for a patient for three visits to an orthopedic specialist.    Once those three visits are up, it may be up to the patient to check in with the PCP for more referral visits, if necessary.   A good specialty practice may pick up that the number of authorized referral visits have been used up, but we should never assume this will happen. In addition, referrals are not “automatically extended”.  Therefore, it’s up to the patient to pay strict attention to their referrals, for time frame and/or number of visits allowed, and be proactive in following up for new referral visits if necessary.