Wiki referring physician

[joy63]

Having denial problems. can someone please remind me the rule for when you do or don't use a referring physician for medicare and commercial plans. we are using our doctor if a referring dr is not listed when x-rays or a procedure is performed. some insurance co are denying, can we or can we not do this? getting different answers from different sources. confused!!

Thanks for your help

 

[ABonnell CPC]

This would really depend in each insurance company and the pt's individual policy. UHC for example, one pt may need a referring physician, but another may not. The best thing would be to contact the insurance company. Are you getting authorization for the procedures?