Referral Forms

You must give us all written referral forms and information BEFORE the visit begins in order for us to determine that all anticipated services will be covered. If you do NOT have this information BEFORE the visit, you may be responsible for some or all of the visit charges that insurance does not cover. We will inform you in advance when we have any reason to believe that scheduled services are not covered by your plan. In the circumstance that a non-covered service is recommended, we will ask you, in advance, to sign a form that states you will be responsible for the payment of any non-covered charges for the proposed procedure. Finally, your health plan makes all final determinations of coverage. Their coverage decisions are normally final; you will be financially responsible for any services we provide that are not covered by your health plan.