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. PMA 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.)