Whats the difference between a referral and an authorization?
A referral is a written directive from your physician to another in-network John Muir Physician Network physician. The written referral is good for up to six months from the date of issue. An authorization is a request for service that requires formal review by the John Muir Physician Network. Before many types of specialized services are provided, such as a non-emergent hospital admission, surgery, and durable medical equipment, medical necessity is reviewed by the John Muir Physician Network on behalf of your HMO. Your Physician is familiar with this process and will request prior authorization from the John Muir Physician Network when necessary. The John Muir Physician Network reviews these requests and responds to your physician quickly. Your physician will notify you of the outcome of our decision. It should be noted that an authorization is not guarantee of payment. You must be eligible on the date of service.
