Circle Medical may be able to bill your appointments through your HMO plan. Before we can, your insurance usually needs an approved referral from your insurance-assigned primary care provider (PCP).
This article explains each step, how long it usually takes, when to reach out to us, and what to do if something doesn't go to plan.
Looking for something else? This article is about your HMO referring you to Circle Medical so we can bill your visits.
If your Circle Medical provider is referring you to a specialist, see How specialist referrals work at Circle Medical.
If your student health plan requires an authorization before Circle Medical can see you, see Student health plans below.
Prior authorizations for prescriptions, imaging, labs, and medical equipment are a different process. See How prior authorizations work at Circle Medical.
What is an HMO referral?
An HMO plan coordinates your care through one assigned primary care provider (PCP). Before the plan will cover a visit with another provider, including Circle Medical, it usually requires that PCP to request a referral. Your insurance plan may call this a referral authorization.
If the plan approves the request, it sends you a referral document and number. That document is the plan's record that the visit was authorized. Share it with Circle Medical. We verify it with your insurance and attach the referral information to your appointment claim so your insurance plan can process it.
We can't book your appointment until we have the approved referral document and number. Without it, your insurance plan may deny the claim.
Tip: Keep your insurance information up to date and uploaded to your profile. See How to add, update, or remove your insurance.
When a referral isn't needed
Your Circle Medical provider is already your assigned PCP
You do not need a referral, or an approved referral document, for Circle Medical to bill your appointments through your HMO.
This is separate from a referral to a specialist or an outside facility, such as cardiology or imaging. Talk with your provider during an appointment if you need one of those. See How specialist referrals work at Circle Medical.
Your HMO is an open access plan
If your HMO plan is open access, you do not need a referral from your assigned PCP.
How long does an HMO referral take?
Each stage has its own clock. In most cases, you receive the approved referral document within 1–2 weeks of asking your PCP.
You find your PCP and request the referral. This depends on how quickly you can reach the office.
Your PCP submits the request and your insurance reviews it. Usually 1–2 weeks. It can take up to 30 days if more documentation is needed, the PCP's office is backlogged, or your plan asks for more information.
You share the approved document with Circle Medical. The support team verifies it with your insurance and helps book your appointment.
Step 1: Find your assigned PCP
Look at your insurance card, or log in to your insurance portal. Your assigned PCP's name should be listed there.
Step 2: Ask your PCP to request a referral
Call your PCP's office, or send a message through their patient portal. Tell them:
You need a referral to see a provider at Circle Medical.
The type of care you're seeking, such as primary care, mental health, or ADHD care.
The visit will be by telehealth.
Tip: Your PCP may ask why you want the referral. Be ready to briefly describe your symptoms or goals.
Step 3: Wait for your insurance to approve the referral
After your PCP submits the request, your insurance reviews it. If they approve it, they create a referral document with a number and the other details Circle Medical needs to bill the appointment through your HMO.
Step 4: Get the referral document from your insurance
Once your plan tells you the referral is approved, you can usually find the document by:
Checking your insurance member portal, or
Calling the member services number on the back of your insurance card.
Keep in mind: Every portal looks different, and referral numbers vary in length and format.
Confirm the document includes:
Your referral number
Start and end dates
Your PCP's information
The total number of approved visits
Step 5: Share the referral document with Circle Medical
Start a chat in the mobile app or web portal, select HMO Referral, and follow the prompts to share your referral document.
The support team verifies the referral with your insurance and helps book your appointment.
When to contact the support team
Most of the wait happens with your PCP and your insurance. Contact Circle Medical at these points:
You have the approved referral document. Start a chat, select HMO Referral, and share it.
Your plan says a referral isn't required. Start a chat so we can confirm whether we can bill your HMO.
What to do if something goes wrong
I don't know who my PCP is
Check your insurance card, or log in to your insurance portal. Your assigned PCP should be listed there. If you don't have a PCP, you'll need to choose one.
I don't have an assigned PCP
HMO plans usually require an assigned PCP before they will cover visits to Circle Medical. Log in to your insurance portal, or call the member services number on the back of your card, and ask them to assign one.
My referral is taking longer than expected
On average, it takes 1–2 weeks for your PCP to submit the request and for you to receive the document. It can take up to 30 days if more documentation is needed, the PCP's office is backlogged, or your plan asks for more information.
To move it along:
Call your PCP's office and ask them to submit the referral as soon as possible. Don't rely on a portal message alone.
Follow up with your insurance 2–3 days after your PCP submits the request. Confirm they received it and ask for the status.
If you're seeking ADHD care, ask your insurance: “Does behavioral health have a direct-access exception?”
Once the referral is approved, share the document in chat on the app or web portal. The support team will help schedule your appointment.
My plan says I don't need a referral
If you asked your assigned PCP for a referral and your HMO said one isn't required, Circle Medical may still be able to bill your appointments. Start a chat and ask the support team to confirm.
My PCP declined the referral
This is uncommon. You can appeal with your insurance. Call the member services number on your card to learn your options.
I don't want to wait for a referral
You can book as a self-pay patient.
Important note: If you choose self-pay, Circle Medical will not bill your HMO for the appointment, and you pay the full self-pay cost. Your HMO may not reimburse you for that visit, even if a referral is approved later.
Student health plans
Student health plans often require an authorization before they will cover a visit with a provider outside the school, including Circle Medical. Your plan may call this an authorization, a referral, or a referral authorization.
Circle Medical cannot request this authorization for you. It has to come from your student health plan. Your plan may tell you to start with your campus student health center.
We can't book the appointment through your student health plan until we have the approved authorization. Without it, your plan may deny the claim.
Contact your student health plan. The member services number is usually on the back of your insurance card. Ask whether you need an authorization to see an outside provider by telehealth or in-person, depending on your appointment type.
If you do, ask them to start it. Tell them the appointment is with Circle Medical, if it will be by telehealth or in-person, and what kind of care you need, such as primary care or mental health.
When your plan approves it, get the authorization document. Confirm it includes your authorization or referral number, the start and end dates, and how many appointments are approved.
Contact support and share the document. Tell us it is for a student health plan. The support team verifies it with your plan and helps book your appointment.
If your plan says an authorization is not required, reach out to support so we can confirm whether we can bill your student health plan.
If you don't want to wait, you can book as a self-pay patient. Circle Medical will not bill your student health plan for that visit, and your plan may not reimburse you later.
The troubleshooting sections above apply to student health plans as well as HMOs.
Related articles
Specialist referrals: How specialist referrals work at Circle Medical
Prior authorizations: How prior authorizations work at Circle Medical
Insurance on your account: How to add, update, or remove your insurance
Still have a question about an HMO referral? Start a chat in the app or web portal and select HMO Referral. If you already have your referral document, include it so we can help faster.