If you have an HMO plan, you will probably require a Referral from your Primary Care Physician (PCP). If you have a PPO plan, you probably do not require a Referral. Regardless of what type of plan you have, if you are under the care of a PCP you should discuss your situation with him/her because the PCP will understand the requirements of your Health Plan and the PCP is often the one required to make the Referral. If you do not have a PCP, or you still have questions, please call the member services number on your insurance ID card.
Generally if you do not require a Referral, then no Prior Authorization is necessary. If you do require a Referral, it is the responsibility of the physician giving you the Referral to get the Referral properly authorized. However, you as the patient must ensure that you do have a properly authorized Referral (if one is required by your plan) before visiting a USF physician.
There are several problems that could arise if your Referral is not properly completed with any required Prior Authorization before you receive services at USF. While Health Plan rules vary, here is a sample of what may happen:
Your appointment with the USF physician or service may be delayed until the Referral is made/properly authorized.
For some Health Plans, you may be responsible for payment of the bill.
Some Health Plans that require a Referral from your Primary Care Physician to see a Specialist apply this same rule for Specialist-to Specialist Referrals. This means that only your Primary Care physician can make a Referral to another Specialist. If your USF physician needs to refer you to another Specialist, you should check first with your Health Plan to see if the Referral must come from your Primary Care Physician.
Only the USF Department of Family Medicine and the USF Division of General Pediatrics act as PCPs for HMO Members. If your HMO is one that USF participates with and you need a PCP for Members under the age of eighteen, you may select a USF general pediatrician. For adult Members, please check with your Health Plan to see if a physician from the USF Department of Family Medicine is currently accepting Members from your plan.
That depends on a variety of factors such as your coverage and if your Deductible has been met. As a minimum, you will be required to pay, at the time of service, any Co-Payments that your Health Plan requires. You may also have to pay some or all of the Co-Insurance your plan requires. Also, if you have not met your Deductible, you may have to pay some or all of the costs of Covered Services that your plan will not pay for because the Deductible has not been met. USF follows standard medical industry policies in regards to these payments, so your payment at the time of service will be very similar to what you have paid to see other (non-USF) physicians.