Referrals

At One Medical Group, we’re well-equipped to manage most of your medical needs from general preventive care to acute illness, injury and chronic disease. Nevertheless, there will be times you may need to see a specialist. Though insurance rules are often complex and evolving, here are some recommendations we can offer to make your referral process much simpler.

1. Complete your Personal Health Summary

If you haven’t yet done so, we recommend you complete your Personal Health Summary (PHS). This will allow us to have a complete picture of your medical health and allow you to share that information with the specialist of your choice.

2. Determine if you need to be seen by a specialist

If you are unsure if you need to see a specialist, then it’s probably best to just schedule a visit with us at One Medical Group. We can address your issues 90% of the time on the same-day. And it beats having to wait several weeks for an appointment with a specialist.

If you have a specialist who you regularly see about a rare or complicated issue, then it’s probably fine to go straight to that specialist. Read the next section on health insurance rules to determine what you should do next.

3. Confirm your health insurance type and rules

Check your insurance card and determine what kind of insurance you have.

Most patients with PPO insurance do not need a referral. If that’s the case, simply find a physician you want to see and schedule an appointment with that physician. Often, your health plan will have a directory of approved specialists so check that first.

If you have HMO insurance, then you will probably need a referral from us as your primary care physician (make sure you have selected one of us as your primary care physician; otherwise, the referral may be denied and you may be charged by your health insurance company).

If you have a specific physician you want to see, check with your insurance plan to make sure he/she is “in-network” or covered by your HMO. If you don’t care about who you see, then we can refer you to an HMO provider that we work with regularly.

4. Send us an email

If you have determined that you have HMO insurance and would like to see a specific specialist who accepts your HMO insurance, then please email us the following:

1. Name of the specialist and his/her specialty
2. Specialist’s phone number, address and fax number
3. A brief history about your medical condition