Learn How your Insurance Plan Processes your Referral Requests

Your insurance plan may require a referral authorization for you to see a specialist. Before you schedule the appointment, you need to be aware of the outlined steps for processing times. Our office typically takes about 24-48 hours to process your referral requests before submitting the order to the insurance company.

Once the insurance company receives the order, processing times vary depending on the network and plan. Keep reading to learn more about the specific process for your network and plan.

• Aetna Network and Plans typically have a processing time of 2 to 3 business days and are eligible for one year per diagnosis.
• For BCBS HMO, the processing time is within two to three business days, and it is eligible for up to six months per diagnosis.
• For BCBS POS, the processing time is 2 to 3 business days, and it is eligible for 3 months per diagnosis.
• Cigna, including HMO, POS, Healthspring, and Medicare insurances, takes seven business days to process our request. Once approved, it is eligible for one year per diagnosis.
• Humana Commercial or Medicare PPO does not require authorization.
• For Humana Commercial or Medicare HMO, the processing time is 2 to 3 business days, and it is eligible for up to 6 months per diagnosis.
• For Ambetter HMO plans, the authorization requirements vary depending on the plan. The processing time is typically 2 to 3 business days once submitted through the Ambetter portal, and it is eligible for up to 6 months per diagnosis.
• For the United Healthcare commercial, Medicaid, Medicare, and WellMed plans, no authorizations are required to see specialists.
• For the United Healthcare marketplace plan (TXONEX), an authorization for referrals is required.
• WellCare, an HMO Medicare Advantage plan, takes 14 calendar days to process requests. Once submitted, they review the request for up to 7 days, totaling a processing time of 21 days. The authorization is valid for 2 months per diagnosis and covers up to 10 visits.

Please be aware that if you require a referral for an additional or new diagnosis or your eligibility for the referral has expired, you will require a medical office visit for evaluation and to start a new request.