How to See a Specialist

How to See a Specialist   |   Direct Access to Obstetrical/Gynecological Care   |   How to Obtain a Standing Referral
How to Have a Referred Specialist Designated as Your Primary Care Physician   |   How to Plan For Hospital Care
Continuity of Care

How to Have a Referred Specialist Designated as Your Primary Care Physician

If you have a life-threatening, degenerative or disabling disease or condition, you may have a referred specialist named to provide and coordinate both your primary and specialty care. The referred specialist will be a physician with clinical expertise in treating your disease or condition. It is required that the referred specialist agrees to meet the plan’s requirements to function as a primary care physician.

Follow these steps to initiate your request for your referred specialist to be your primary care physician:

1. Call the Caring Foundation at 1-800-464-5437. (Or, you may ask your primary care physician to call the provider services or patient care management department to initiate the request.)
2. A “Request for Specialist to Coordinate All Care” form will be mailed or faxed to you.
3. You must complete a part of the form and your primary care physician will complete the medical part. Your primary care physician will then send the form to Keystone’s patient care management department.
4. The medical director will speak directly with the primary care physician and the selected referred specialist to inform all parties of the primary services that the referred specialist must be able to provide in order to be designated as your primary care physician. If the patient care management department approves the request, it will be sent to the provider service area. That area will confirm that the referred specialist meets the same credentialing standards that apply to primary care physicians. (At the same time, you will be given a standing referral to see the referred specialist.)