When your OCHS primary care provider (PCP) determines you need specialized care, your OCHS PCP will “refer” you to a specialized provider. A referral may be required by your insurance before your plan will provide payment for certain services. Below are answers to commonly asked questions about referrals.

How do I know if my health plan requires referrals?

Check your insurance plan member portal for coverage guidelines or call your plan’s member services department at the number on your card. It is important that you fully understand your plan’s referral requirements. If you do not get a required referral prior to receiving non-emergency care, you may be responsible for the entire bill (not just a co-payment or deductible). Please check the back of your insurance card for your specific number to call.

Why do I have to check with my PCP before seeing a specialist?

Depending on your insurance plan, it may be required. Your PCP best knows your medical history and is most qualified to work with you in deciding if you need to see a specialist.

Do I need a referral for an X-ray or Routine Screening Mammography?

It depends on what you are having done. If it is a routine x-ray, or Routine Screening Mammogram, your PCP can send the order for you to have it done the same day.

For testing, such as ultrasounds, mammograms, and bone densities, Cape Cod Hospital will call you directly to schedule. If you do not hear from Cape Cod Hospital within three days, we suggest that you call the Hospital’s central scheduling at (508) 957-8600.

If your referral is other than Cape Cod Hospital, you will be asked to call directly to register and schedule your appointment.

Do I need a referral for a CAT, MRI or PET Scan?

If you are having a “Hi-Tech” exam, such as an MRI, CAT scan, or PET scan, your insurance company most often will require prior approval before the test can be performed. Once an OCHS Referral Coordinator receives an authorization or denial, you will be contacted to schedule an appointment by Cape Cod Hospital (for CT scans) or Shields MRI (for MRI and Pet scans).

Referrals/ Authorizations required by your insurance for Cape Cod Hospital “Hi-Tech” images are obtained by OCHS Referral staff members.

What is the Status of my Referral?

If you have MyChart, feel free to review the referrals section. This will contain info about the specialist you are referred to and actual referrals made.

If you have already signed up for the Patient Portal, this is the default method in which we will notify you of your referral status unless your referral is marked urgent by the provider. In that case, you will receive a phone call.  

If you have not registered on the Patient Portal, please visit our MyChart Page. We will be happy to help you through the process.

If you have questions, please feel free to call our Referral Team at 774-209-3233. Our team is available to assist you Monday- Friday 8:00 am-4:30 pm. After hours, please feel free to leave a voicemail.

How soon will I get my appointment with the Specialist?

Specialists will call you directly to schedule the appointment. If the specialist is unsuccessful in reaching you, their office will notify the referral department which will then inform your provider.

Specialists do their best to get you an appointment in a timely manner depending on what you are being seen for; however, some specialists are very busy, often booking several months out. If you do not hear from them in a timely manner, you can call the specialist office directly.

If you are referred to a specialist at Beth Israel Deaconess Medical Center (BIDMC), you must register with them before we can send a referral. Please call (617) 754-8240. Once registration is complete, BIDMC can transfer you directly to the specialist to schedule.

What if I see the Specialist without obtaining a referral?

If you see a specialist and a referral is required, your PCP may not give the referral after you have seen the specialist. Specialists should be aware if a referral is required prior to seeing you. If you receive a bill from the specialist and you did not get a referral, you will need to discuss this with your insurance company. Ultimately, you are responsible for obtaining a referral prior to your appointment.

Ultimately, you are responsible for obtaining a referral prior to your appointment. To obtain a retroactive referral. Please message via MyChart the referral team or call our Referral Department.

What if I need an Out-of-Network referral?

Your insurance may not cover out-of-network referrals. We advise that you contact your insurance company to determine if providers are “in” or “out” of your specific network.

I am a new OCHS patient who has not been seen yet. Can I get a referral?

Until we can appropriately assess your medical history at your new patient appointment, we are unable to provide referrals for patients not yet seen by an OCHS clinician.

Where can I find more information?