Insurance and Managed Care
If you need specialty care, your Primary Care Provider (PCP) will refer you to a specialist or
hospital within the CareGroup Healthcare System that best meets your needs.
If the specialist suggests that you see another specialist, please contact
your PCP, who will arrange for any additional referrals.
Many HMOs require that referrals be approved prior to any scheduled
appointment with a specialist. Without a referral, your health care insurer
could refuse to pay the specialist's bill, and you could be held
responsible for the cost of the office visit.
When you need a referral, please note:
Call our referral coordinators through the main office number (617-754-9600) and select the "managed care referral"
Referrals are processed Monday through Friday during regular office
It is best to contact us as soon as you have an appointment.
Please allow 3-4 business days to process routine referral requests.
Carefully complete your referral information so we can promptly process
Referrals are limited to a certain number of visits and/or may only be
valid for a specific length of time. If you have follow-up visits
scheduled with a specialist, please check before your appointment to
confirm that your current referral will cover these visits.
If you change insurance plans…
If you change insurance plans, please be sure that the correct Primary Care Physician (PCP) is listed with the new plan. Bring your most current insurance
card to your next appointment. If you have already processed a referral for
a future appointment while covered under your old plan, please call our
managed care coordinator to arrange an updated referral.