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 Child’s Primary Care Physician

If your child has a life-threatening, degenerative or disabling disease or condition, your child may have a referred specialist named to provide and coordinate both your child’s primary and specialty care. The referred specialist will be a physician with clinical expertise in treating your child’s 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 child's referred specialist to be your child's primary care physician:

1. Call member services at 1-800-464-5437. (Or, you may ask your child’s 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 child’s primary care physician will complete the medical part. Your child’s 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 child’s 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, your child will be given a standing referral to see the referred specialist.)

If The Referred Specialist as Primary Care Physician Request is Approved
If the request for the referred specialist to be your child’s primary care physician is approved, the referred specialist, your child’s primary care physician and you will be informed in writing by the patient care management department.

If The Referred Specialist as Primary Care Physician Request is Denied
If the request to have a referred specialist designated to provide and coordinate your child’s primary and specialty care is denied, you and your child’s primary care physician will be informed in writing. You will be given information on how to file a formal complaint if you want to.