Whats the difference between a referral and an authorization (HMO only)?
A referral is a written directive from your physician to another in-network Brown & Toland provider. 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 Brown & Toland. Before many types of specialized services are provided, such as a non-emergent hospital admission, surgery, durable medical equipment, infusions and certain tests, benefit coverage, member eligibility, and medical necessity are reviewed by Brown & Toland on behalf of your HMO. Your physician is familiar with this process and will request prior authorization from Brown & Toland when necessary. Brown & Toland reviews these requests and responds to your physician quickly. You will receive a formal letter detailing the outcome of our decision along with specific valid to and from dates. It should be noted that an authorization is not a guarantee of payment. You must be eligible on the date of service.
