Request a Referral

Many health insurance plans, especially managed plans like HMO’s, require you to receive approval from your pediatrician (PCP) before you take your child to a specialist.  You then must obtain a referral number.

Please be aware that insurance companies can deny payment for services even if you have a referral.  You must call your insurance company directly about which services may not be covered.

If your insurance is a “managed” type (if you don’t know, call your insurance company), please follow these steps:

Step 1:  Verify with your insurance company that you need a referral.  Even if your insurance is managed, you may not need a referral for some services.  Example: most companies do not require a referral for laboratory tests.  Companies that have PPO plans do not require referrals.  Check with your insurance 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 our office first because your pediatrician or nurse practitioner can often expedite your emergency room visit if one is necessary.

Step 3:  Make an appointment with whom your provider has referred you.  When you call the specialist, be sure to ask for all of the information requested below (#4).  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.  Please call the office at 617-745-0050.  You may be directed to leave information on our automated referral line.  Please give us the following information:

  1. Your full name
  2. You child’s full name, date of birth, insurance information, and PCP
  3. Your telephone number (in case we need to contact you)
  4. Specialist’s first and last name, specialty, address, telephone number, fax number, and NPI number
  5. Date of Appointment and Reason for Appointment

Please note:  It takes approximately 5 business days to process your referral.  Referrals may take longer if all information is not provided.

In addition to calling the office for referrals, patients or their parent/guardian can also use our Patient Portal to request these services.