Referrals, Authorizations & Insurance Changes

Referrals, authorizations, and coverage are related, but they are not the same thing.

Referral: A referral generally means that your primary care provider has directed you to see a specialist. Some insurance plans require a referral before you can receive specialty care.

Authorization: An authorization is approval from your insurance plan or medical group for a particular visit, service, or procedure. Depending on your insurance plan, authorization may be required for office visits, procedures, or other services.

Before Your Office Visit

If your insurance plan requires a referral or authorization for your specialist visit, the required referral or authorization must be received by Peninsula Gastroenterology before your appointment.

Before a Procedure

Peninsula Gastroenterology will check whether authorization is required for your procedure and obtain or confirm authorization when applicable. In many cases, procedure authorization is not required, and therefore no authorization is obtained.

Coverage: Coverage refers to how your insurance benefits apply to the services you receive and how your insurance processes the resulting claim. Even when a visit, service, or procedure has been authorized, your deductible, copay, and/or coinsurance may still apply.

Authorization does not guarantee payment or mean that your visit, service, or procedure will be covered at 100%.

If Your Insurance Changes

Please notify Peninsula Gastroenterology as soon as possible if your insurance changes, especially if you have an upcoming appointment or procedure.

A change in insurance may affect our participation with your plan, referral or authorization requirements, and your benefits or out-of-pocket responsibility. Providing your updated insurance information as early as possible gives our office time to review any requirements that may apply before you receive services.

If we are not notified of an insurance change before services are provided, required referrals or authorizations may not be obtained, which could result in the insurance carrier denying the claim and the patient being responsible for the charges.

Do not wait until the day of your appointment or procedure to notify us of an insurance change.