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About Managed Care Referrals

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Please note: If you are not a University of Washington Medical Center patient, please be aware that the information provided here may not be how your own clinic processes referrals to specialists.

What is the purpose of a referral to a specialty clinic from my Primary Care Provider (PCP)?

A referral from your PCP:

  • Tells a specialist that you need to be seen
  • Informs your insurance company that your PCP has approved of your visit to a specialist. Most managed care companies will not pay for care that has not been authorized with a referral.

How do I obtain a referral?

Schedule a visit with your PCP, who will evaluate your problems. If your PCP decides that you should see a specialist, a referral will be written.

Can I get a referral from any provider I see?

No. For your insurance company to recognize the referral, it must come from your designated PCP or a provider who is covering for your PCP. For example, if your orthopedic doctor refers you for physical therapy, you also need to obtain a referral from your PCP to process through your insurance company.

How do I extend a pre-existing referral?

Please call your clinic. If you are a UWMC Women's Health Care Center patient, please call our managed care voice mail at (206) 598-7650. You need to have this information ready when you call:

  • Your name
  • Your U-card number (on your purple hospital card)
  • The name of your PCP
  • The name of your health insurance company
  • The specialist's name (spelled), fax number, phone number or address with zip code
  • The reason or diagnosis for which you are seeing a specialist

Based on your problem, you may need to see your PCP again.

What happens to a referral after my PCP has written it?

Referrals must be processed based on your insurance company's guidelines. This may take several days. Please make sure we have your current insurance information. Incorrect information will cause delays in processing your referral. They can also affect payment by your insurance company later. Update your insurance information by calling University of Washington Medical Center Registration at (206) 598-4846. Copies of your referral are sent to the specialty clinic, your insurance company and to you in the mail. The original referral is filed in your medical chart.

How do I get an appointment with the specialist I am referred to?

The specialty clinic will call you to make the appointment after they have reviewed your referral. If you have not heard from them within a week or so, you can call them.

Does having a referral guarantee that my insurance company will pay for my specialty care?

No. A referral just means your PCP would like you to be seen by a specialist and approves it. To find out about your benefits, please call you insurance company. You should also call to be sure they have received and processed you referral.

Who can I talk to if I have managed care concerns?

Call your clinic. If you are a patient at the University of Washington Medical Center's Women's Health CAre Center, please call Debra Young, the Managed Care Program Coordinator for Women's Health Care Center at (206) 598-5500. For a list of preferred providers and or benefit information, contact your insurance company.

Debra Young
Managed Care Coordinator,
Women's Health Care Center
University of Washington Medical Center
Patient Education

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