HMO Members
Patients who are part of the HMO plans with Brown and Toland Physicians and Hill Physicians are required to get a referral from your Primary Care Physician (PCP) in order for you to see a specialist (i.e. allergist, pulmonologist, orthopedist, etc.) that is in your HMO Network. If you feel there is a need to see a specialist, please contact your PCP and if necessary a referral will be generated.
Prior Authorizations are required for certain procedures, durable medical equipment and to see a doctor that is “out-of-network.” Prior Authorizations can be requested through your PCP. Our office sends a request for the service or equipment to your HMO with any supporting documentation of why we are requesting the service or equipment. The HMO reviews the information and makes a decision to approve or deny the request based upon various factors. To see if a procedure or equipment needs to be authorized, you should contact your HMO.
Non-HMO’s
Most PPO plans and other non-HMO care plans do not require referrals or authorizations to be generated from your PCP. However, it is impossible for our office to know what each plans policies are and what the covered benefits of each plan are. Please contact your insurance company if you are unclear on what your policy requires.