Circle Medical may be able to bill your appointments through your HMO plan, but there are a few steps you’ll need to complete before we can confirm whether your HMO will cover your care with Circle Medical.
If your PCP determines you need care from another provider, your PCP will typically submit a referral request to your HMO plan for approval. If the referral is approved, your insurance plan should issue a referral document and number.
Because HMOs have strict rules about how care is covered, there is an important requirement to know upfront: We won’t be able to schedule you an appointment with a Circle Medical provider until you provide us with the referral document and number that has been approved and sent to you by your insurance.
Without the approved referral document from your insurance, your insurance may deny your claim. To help avoid surprise bills and ensure you receive the care you need, this article explains how to get and submit your referral documentation.
Tip: Ensure all your insurance information is up to date and is uploaded to your profile.
Why do HMOs require a referral?
Think of your assigned primary care provider (PCP) as the "gatekeeper" of your health insurance. With an HMO plan, your insurance may require your regular doctor to provide a digital "permission slip," also called a referral authorization, before they will cover care from another provider or specialist (including telehealth providers like Circle Medical).
Once approved by your insurance, the referral authorization includes a unique referral number.
You’ll need to share this number with Circle Medical so we can double-check that you’re all set for your appointment. If everything looks good, Circle Medical will attach the referral information to your appointment claim so your insurance has the referral information it needs to process the claim.
How to obtain a referral
To ensure your appointment is covered, you'll need to do a little bit of homework before you can officially lock in your appointment.
Step 1: Find your assigned Primary Care Provider (“PCP”)
Look at your physical insurance card or log into your health insurance portal. Your assigned PCP's name and clinic should be listed right there.
Step 2: Contact your PCP’s office
Call your PCP’s front desk or send a message through their patient portal (like MyChart). Tell them:
You need a referral to see a provider at Circle Medical.
Specify the type of care you are seeking (e.g., primary care, mental health management, ADHD care).
Mention that the visit will be conducted via telehealth.
Tip: Your PCP might ask why you want the referral, so be prepared to briefly describe your symptoms or goals.
Step 3: Wait for your insurance to process the referral
When your PCP submits the referral, your insurance needs time to process the request. In most cases, if your insurance approves the referral, it will generate a referral document that contains a number and other relevant information. The referral information provided by your insurance allows Circle Medical to bill your appointment through your HMO plan.
Step 4: Locate your referral information from your insurance
Once your insurance notifies you that your referral has been approved, you’ll be able to access your referral number. You can usually find this by:
Checking your insurance's online member portal.
Calling the member services number on the back of your insurance card.
Keep in mind: Every insurance portal looks a bit different, and the numbers vary in length and format.
Step 5: Share the referral document and other relevant information with Circle Medical
Once you have your referral number in hand, reach out to our Care Team through the mobile app or web portal by selecting the ‘HMO Referral’ button when starting a new chat. Our Care Team will verify the referral information with your insurance to ensure everything is aligned and help book your appointment. This information includes:
A referral number
Start and end date for the approved referral
PCP information
Total visits approved
Important note: The referral from your PCP is a necessity. We won’t be able to process your claim through your HMO plan without the proper referral documentation
Taking the time to request a referral and obtain a referral document from your insurance helps reduce the risk of billing errors or surprise costs. If you have any questions, start a chat on the mobile app or web portal. Our Care Team is here to help guide you through it!
FAQs
How long does it take to get a referral and subsequent referral documentation from my HMO?
On average, it takes 1-2 weeks for your PCP to submit the referral request and for you to receive your referral documentation.
Important note: The timeline for receiving a referral and referral approval varies based on your insurance and PCP’s office.
From our experience working with patients, the process can take up to 30 days in some cases, especially if additional documentation is needed, the PCP office is backlogged, or your insurance plan requests more information before approving the referral.
Remember: once you have your referral approved, please share your referral information via HIPAA-compliant chat on the mobile app or web portal. The Care Team will work with you to schedule your appointment as quickly as possible. The information you will need to provide is: a referral number, a start and end date for the approved referral, PCP information, and total visits approved.
Is there anything I can do to speed up the process?
Here are some tips for trying to get your referral approved quicker:
Call your PCP's office directly and ask them to submit the referral request as soon as possible. Don't rely on a portal message alone.
Follow up with your insurance 2-3 days after the referral request from your PCP was submitted to confirm receipt and check the status.
If you're seeking ADHD care through Circle Medical, ask your insurance: “Does behavioral health have a direct-access exception to speed up the process?”
Do I have other options if I don’t want to go through the process of getting a referral approved?
Yes! If you don’t want to wait for your PCP and your insurance to process your request and provide approved referral documentation, you can book your appointments as a self-pay patient.
Important note: If you choose self-pay, Circle Medical will not bill your HMO plan for the appointment, and you’ll be responsible for the full self-pay cost. Your HMO may not reimburse you for self-pay appointments, even if you receive an approved referral later.
What if I don’t know who my PCP is?
Check your insurance card, or log into your health plan's app or website, and your assigned PCP should be listed there. If you don’t have a PCP, you will need to select one.
What if my PCP says no to the referral request?
It's rare, but if your PCP declines the referral request, you have the right to appeal with your insurance. You can also call the member services number on your insurance to learn about your options.
As a patient with an HMO plan, how do I book my appointment?
Here's what you need to do before we can book your appointment:
Find your PCP. Check your insurance card or log into your insurance portal to find your assigned primary care provider.
Request a referral. Contact your PCP's office and ask for a referral to Circle Medical. Let them know the type of care you're seeking and that the appointment will be via telehealth.
Get your approved referral documents. Once your PCP submits the referral request, your insurance will review it. If approved, you'll typically receive documentation and a referral number, usually within 1–2 weeks.
Share your referral information with us. Open the mobile app or web portal, start a new chat, and select the "HMO Referral" button. Our Care Team will verify your referral information and get your appointment scheduled.
New patient? Learn how to start a new chat to get started.