Referral to a Specialist from WCHC: When, Why, and How?

Your healthcare provider is the person you generally turn to for most of your routine care, preventive services, and any health concerns you might have. It’s important to establish an ongoing relationship with your provider, as they’re most familiar with your health history and overall wellness. Your provider can assist with things like:

• Routine Checkups
• Preventive services (e.g. screenings, immunizations)
• Common medical or behavioral health conditions
• Initial diagnosis
• Chronic disease management
• Referral to and coordination of care with specialists and other providers

Your healthcare provider can manage most of your chronic diseases but as health care becomes more advanced, there is an increasing need for patients to see specialists.  Specialists have advanced education and training in specific areas of medicine and have access to sophisticated diagnostic tests and treatments. You may be asked to see a specialist for:

• Management of some complex chronic conditions
• Diagnosis and treatment of rare diseases
• Diagnosis and treatment of certain acute conditions, such as metabolic disorders, or cancer
• Certain procedures and surgeries, such as orthopedic surgery
• The latest treatments and expertise in a specialty
• Reproductive health (such as OB-GYN)
• A condition that is not improving
• Cutting-edge or experimental treatments

Together, we will coordinate your care with the specialist to make sure you don’t undergo any treatments or medications that would be especially risky for you, based on your medical history, prescriptions, or other reasons.

My healthcare provider referred me to a specialist. What should I do next?

WCHC will provide you with a list of specialists that we typically work with, however, this is not a guarantee that they are in network with your insurance or that they are accepting new patients. Please note, there is no financial relationship or endorsement between these providers and WCHC.

For your convenience, our website also offers a list of local specialists to support your healthcare needs. Please be aware that this list is updated periodically and is not comprehensive.

If you would like a list of specialists in your area that are in your network and accepting new patients, please call the member services phone number on the back of your insurance card. 

Once you have chosen the physician you will be seeing, you will need to call WCHC with the following information so that we can complete your referral authorization.

• First and Last name of the provider you are seeing
• The phone number for the provider you are seeing
• Date of the scheduled appointment
• Location of the appointment

What is a referral authorization?

A referral authorization ensures that the insurance is aware of the need and will pay for the visit.

How much notice do you need to complete my referral?

WCHC kindly asks that you provide us with the needed information 5 business days, excluding weekends and holidays, before your scheduled appointment so that we can gather proper documentation to complete the authorization and fax the information to the specialist.

Need Help Scheduling Your Initial Appointment?

If you need assistance scheduling your first appointment with a specialist, please call our office. We can connect you with one of our care coordinators who will help guide you through the process and ensure everything is arranged smoothly.