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 Obtain a Standing Referral

If your child has a life-threatening, degenerative or disabling disease or condition, your child may receive a standing referral to a specialist to treat that disease or condition. The referred specialist will have clinical expertise in treating the disease or condition. A standing referral is granted upon review of a treatment plan by Keystone and in consultation with your child’s primary care physician.

Follow these steps to start your child’s standing referral request:

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 obtain a standing referral request form.)
2. A standing referral request 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 send the form to Keystone’s patient care management department.
4. The patient care management department will either approve or deny the request for the standing referral. You, your child’s primary care physician and the referred specialist will receive notice of the approval or denial in writing. The notice will include the time period for the standing referral.

If The Standing Referral is Approved
If the request for the standing referral to a specialist is approved, the referred specialist, your child’s primary care physician and you will be informed in writing by the patient care management department. The referred specialist must agree to abide by all the terms and conditions that Keystone has established with regard to standing referrals. This includes, but is not limited to, the need for the referred specialist to keep your child’s primary care physician informed of your child’s condition. When the standing referral expires, you or your child’s primary care physician will need to contact the patient care management department and follow the steps outlined above to see if another standing referral will be approved.

If The Standing Referral is Denied
If the request for a standing referral 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.