Sometimes your care needs a specialist outside of Circle Medical, such as a dermatologist, cardiologist, gastroenterologist, or physical therapist. When that happens, your provider places a specialist referral, and our support team coordinates getting it to a practice that can see you.
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 Circle Medical referring you to a specialist.
If your HMO requires a referral to Circle Medical so we can bill your visits, see How to get your HMO referral.
Imaging, lab orders, and sleep studies follow different processes (see the end of this article).
How long does a referral take?
Each stage has its own clock. In most cases, the whole process takes roughly a week and a half from your appointment to being able to book with the specialist.
Your provider places the order: within 24 hours of your appointment.
We find a specialist and send your referral: typically about 72 hours later. It can take longer during busy periods or if your insurance requires a prior authorization.
You get a message: as soon as the referral has been sent to the specialist.
The specialist processes your referral: Allow up to 5 business days for the specialist to have it on file before contacting. Some specialists may process the referral sooner.
Important note: If your insurance plan requires a prior authorization for the specialist visit, some decisions come back right away and others can take up to 14 days. This is decided by your insurance, not by Circle Medical.
Step 1: Your provider creates a referral order
During your appointment, your provider may decide you need care from a specialist. They place a referral order and finalize their visit notes, which the support team needs before the referral can be sent. Providers aim to do this the same day and within 24 hours of your appointment.
A referral can only be placed for a concern you discussed with your provider. If you'd like a referral for something new, you'll need an appointment first (see Requesting a new referral below).
Step 2: The support team finds a specialist and sends your referral
Our support team looks for a specialist that:
Is near the home address on your account
Accepts your insurance carrier, based on the insurance details saved on your account
Offers the care your provider ordered
We then fax your referral and supporting notes to the practice. If your plan requires a prior authorization, we request it as part of this step. Learn more in What is a prior authorization?
Tip: Keep your home address and insurance details up to date before and after your appointment. We send the referral to a practice based on what is saved on your account, and an out-of-date insurance card is the most common reason a referral has to be redone.
Step 3: You receive a message confirming the referral was sent
Once Circle Medical has sent your referral, you'll get a message in your Secure Care Inbox.
It includes the specialist's name, address, and phone number.
This message is sent automatically and you can't reply to it. If you have a question about your referral, start a chat with the support team instead.
Step 4: Schedule your appointment
Follow the instructions in your Referral Order message:
Wait before you call. Specialists need time to process incoming referrals. Allow up to 5 business days for the specialist to have it on file before contacting them. Some specialists may process the referral sooner, or may contact you directly.
Confirm they're in-network for your specific plan. We refer you to practices that accept your insurance carrier to the best of our knowledge, but insurances offer many plans. Ask the practice to confirm they're in-network for your plan before you book.
Step 5: After your specialist visit
After your visit, the specialist sends a report to your Circle Medical provider and we attach it to your referral. If your Circle Medical provider recommends follow-up care, they'll reach out with next steps. If you'd like to review the results together, book a follow-up appointment.
If it's been more than 2 weeks since your specialist visit and you haven't heard anything from your Circle Medical provider, let the support team know so we can check whether the report was received.
When to contact the support team
Most referrals arrive on schedule. To avoid a wait for an update that is already on its way, use these checkpoints:
No referral sent message after 4 business days from your appointment: start a chat so we can check the order.
The specialist can't find your referral after 5 business days: start a chat and we'll resend or reroute it.
The specialist can't see you for any reason: start a chat and tell us the specialist name and what they told you.
Your insurance or address changed since your appointment: update your account and start a chat so we can re-send the referral if needed.
What to do if something goes wrong
I haven't received a referral sent message
Your referral may still be in progress. Common reasons for a delay:
Your provider is still finalizing the visit notes that must accompany the referral.
We're waiting on a prior authorization decision from your insurance.
The fax didn't go through and we're correcting the practice's details and retrying. This can take a few days.
The practice doesn't accept referrals by fax (see below).
If it's been more than 4 business days since your appointment, start a chat and we'll check the status for you.
The practice says they never received my referral
Faxes can take several business days to be logged by a busy practice, and occasionally go to the wrong department. If the specialist still can't find it after 5 business days, start a chat. We'll confirm the fax number and resend it, or reroute it to a different practice.
The practice can't see me
This can happen when a practice isn't accepting new patients, doesn't offer the service your provider ordered, doesn't take your specific plan, or has had a provider leave. Start a chat and tell us the practice name and the reason they gave. We'll find another practice and send your referral there. Allow a few business days for the new referral to be sent, and you'll receive a new referral sent message when it's delivered.
The practice doesn't accept faxed referrals
Some practices, especially chiropractors, acupuncturists, and massage therapists, schedule online and don't have a fax number. We don't send referrals by email. If this happens, start a chat and we'll either find a practice that accepts faxed referrals, give you a few options to contact directly, or share a copy of your referral order that you can take to the practice yourself.
My insurance requires a prior authorization
Some plans, particularly HMOs, require approval before they'll cover a specialist visit. We request the authorization as part of sending your referral. Some decisions are immediate; others can take up to 14 days. Until it's approved, the practice may not be able to book you. If the authorization is denied, see What to do if a prior authorization is denied.
I want to see a different specialist or practice
If you have a specific practice in mind, or want your referral sent somewhere closer, start a chat with the practice name and, if you have it, their fax number. We'll check that they offer the ordered care and accept your insurance, then send your referral there.
Insurance plans with referral restrictions
Some insurance arrangements limit whether Circle Medical can send a specialist referral for you. Please review these before your appointment so you know what to expect.
HMO plans
HMO plans require all specialist referrals to come from your insurance-assigned primary care provider (PCP). If your Circle Medical provider is your assigned PCP, we can send your referral as usual. If not, you have two options:
Ask your insurance-assigned PCP to place the referral. Depending on your plan, you may be able to switch your assigned PCP to the Circle Medical provider you saw. Once that change is active, we can send your referral.
Book with the specialist as a self-pay patient. Specialist self-pay costs can be high, so check pricing with the practice first.
Learn more in Navigating HMOs at Circle Medical.
Medicaid plans
We aren't able to send any orders, including specialist referrals, for patients with Medicaid as primary or secondary coverage. Your options are to see a Medicaid-contracted provider for the referral, or, if you're no longer covered by Medicaid, to send us a letter of termination from Medicaid so we can update your account.
Requesting a new referral or renewing one
How long is my referral valid? Referrals are valid for 12 months from the date they're placed. Many specialists have their own limits, so if you booked far in advance, confirm with the specialist that your referral is still current.
Can I request a referral without a new appointment? Yes, if both of these are true:
You've had an appointment with Circle Medical in the last 6 months, and
The concern was discussed at that appointment. For example, we can send a physical therapy referral if you discussed an injury with your provider, but not for a new injury that came up afterwards.
Start a chat and tell us which referral you need. Your provider reviews every request and may still ask to see you first depending on the specialty and how long it's been.
What if it's a new concern? If the issue wasn't discussed with your provider, or your last appointment was more than 6 months ago, you'll need to book an appointment first so your provider can evaluate you and decide on the right referral.
My referral expired or the practice wants a newer one. Start a chat and let us know. If you've seen your provider in the last 6 months for the same concern, we can usually send an updated referral without a new appointment.
Not a specialist referral? Other types of orders
HMO referral to Circle Medical: this is your insurance referring you to us so we can bill your visits. See How to get your HMO referral.
Imaging (X-ray, MRI, ultrasound): this is a separate imaging order. Some imaging centers are walk-in, so follow the instructions in your message. Bring a photo ID and your insurance card. Results typically reach your provider in 2 to 3 business days.
Sleep studies: at-home and in-lab sleep studies have their own process. See Get help with sleep concerns.
Lab orders: your provider sends these directly to the lab. They aren't handled as specialist referrals.
Still have a question about your referral? Start a chat in the app or web portal to connect with the support team. Please include the practice name and what you've been told so far so we can help faster.