Referrals

What you need to know

At Pediatric Medical Associates we act as your advocate to obtain the care you need from your insurance company. This often involves the need for a formal referral. We strive to make appropriate referrals when needed and we maintain a referral department of dedicated people to track and follow up on the status of your referral. Most insurance plans require a diagnosis prior to the referral process. Pediatrician CA ask that you be seen prior to most referrals so that we can make a diagnosis and determine the best referral for your child. If you are requesting a renewal of an annual visit with a specialist, call first, because we can sometimes do this over the phone.

The referral process seems at times to be restrictive, but in many cases it does function as a second opinion. If you require another opinion after the referral visit, please let us know. Remember, if your insurance decides not to pay for a referral because it is not a covered benefit, you can still have a consultation but it will not be paid by the insurance company.

When Pediatric Medical Associates make a referral, it may take up to 7 to 10 days for an answer from the insurance company. If there is some reason you need to complete the referral sooner, let us know; otherwise, we ask you wait the five to ten days to get written confirmation or a call from our office.

For any questions regarding referrals, please call 916-924-9337 (option 2.)