Because many insurance carriers require Primary Care Physicians ("PCP") to be "gate-keepers" of speciality care we may be required to provide a referral for any care provided by specialist. Depending on the type of referral required depends on how long it takes. Most PCP-only referrals (i.e. notice to specialist office that we are aware of the need of the services and approve) require a minimum of 48 hours notice prior to any appointment in order for our office to have sufficient time for completing the referral process. If your insurance carrier requires "Prior Authorization" in addition to PCP referral, this process can take up to seven (7) days to complete. Our office does not provide referrals for services that are not Medically Necessary, for conditions previously untreated by Dr. Perryman, when not required by insurance (i.e. most "female problem"/gynecological related medical care can be rendered by a Gynecologist without referral, mental health issues can be seen without referral by psychologist and psychiatrist).
Dr. Perryman will only process and authorize referrals that are received PRIOR to services being rendered. The only exception to this would be due to an emergency (which should not require a referral) or due to circumstances outside of the control of your office. Exceptions will be reviewed on a case by case basis. In order for our office to begin the referral process we must receive a "Request for Referral" at least 48 hours prior to your appointment or services being rendered. Referrals must come from the specialist office and must include the name of the specialist being seen, their insurance identification numbers (i.e. National Provider Identifier or NPI), the procedure codes (CPT-4) and the diagnosis codes (ICD-9) related to the procedures. If the referral is for Blue Cross/Blue Shield HealthSelect we also need the phone number of the office where you will be seen (not the main office number).
Identity Theft/Financial Fraud - a.k.a. Red Flag Rules
The Red Flag Program Clarification Act of 2010 better defines the entities that must conform to the FTC Red Flag Rules. The clarification exempts most physician/healthcare provider offices from having to implement the Red Flag Rules as defined by the FTC. However, at this time our office has adopted internal policies and procedures that we feel are necessary to protect our patients financial information. These policies and procedures reflect the potential for individuals to perform pre-texting activities for the purpose of commiting financial fraud and/or identity theft. As part of these policies our office staff will not release any Patient Financial Information including, but not limited to; Social Security Numbers, Insurance Certificate or Group Numbers. Our staff will confirm the patients insuring company name but no other details will be provided.
