HMO Policies & Referral Request
HMOs were created to help counteract the soaring cost related to providing health care. One way in which HMOs have been successful in doing this is to coordinate your care through a primary care physician. The reason for this is that 80-90% of all medical issues can be handled in a primary care setting rather than in a more expensive specialty office. Therefore as the primary care physician, we are REQUIRED by your insurance to evaluate all medical matters before a referral is initiated.
If we lack the expertise in either the diagnosis or treatment of your medical problem, a referral to a specialist is initiated. Please understand that your HMO plan was chosen by you or your employer and as your primary physician we will work with you within the program guidelines to provide the best health care possible.
Please follow the steps listed below to ensure the proper processing of your HMO Physician Referral request.
Step 1: Obtain the name of a specialist from your NWIM doctor.
Step 2: Call the specialist and arrange for an appointment.
Step 3: Use the on-line request form or call the NWIM referral line to let us know the date of your scheduled specialist appointment.
Step 4: We process the referral
- No authorization for a referral will be provided retroactively for care already provided.
- Unless an emergency, NWIM requires at least five (5) working days to process a physician referral. No exceptions.
- All specialists must be in Premier Physician Network (PPN) and a member of your HMO. (PPN is a network of Beaumont doctors that contract with your HMO to provide medical services.)