Referrals and Prior Authorizations

Referrals

If your primary care doctor (also known as the PCP) thinks that your medical condition requires the attention of a specialist, you may receive a referral to see a specialist at New London Hospital, New London Medical Group, or Newport Health Center. There are some things you should know about a referral:

  • The referral should be to a provider within your health plan’s network.
  • Make certain your health plan covers the referred service.
  • Check for limitations on the referral. For example, there may be a maximum number of visits allowed, or there may be an expiration date for the referral.
  • The referral from your PCP must be sent to the specialist’s office before your specialty appointment.

Prior Authorization or Precertification

Many health plans require patients to receive prior authorization/precertification from their health plan for certain medical procedures or services before the service occurs. Information about your health plan’s specific requirements is usually listed on the back of your health insurance card or in your benefits handbook. Please contact your health insurance plan to inquire about your responsibility to complete these requirements prior to your appointment.