Often, when doctors are out sick, their office staff calls to notify patients and reschedule appointments. Sometimes, instead of rescheduling appointments, a doctor may refer patients to another doctor. Before you get care from a doctor that is covering for your primary care provider, it is your responsibility to confirm with the doctor’s office that you have a referral.
If your health plan doesn’t require a referral, but you plan to see a doctor that is covering for your primary care provider, it is your responsibility to make sure that the doctor is in-network before you receive care.
Failure to confirm that you have a referral or are seeing an in-network doctor can result in no insurance coverage and high out-of-pocket expenses. If this happens, you can try and appeal the claim by following the steps outlined by your insurance company.