HOW TO OBTAIN A STANDING REFERRAL Sample Clauses

The "How to Obtain a Standing Referral" clause outlines the process by which an individual can secure ongoing authorization to see a specialist or receive specific medical services without needing repeated approvals. Typically, this clause details the steps required, such as obtaining a recommendation from a primary care provider, submitting necessary documentation, and meeting eligibility criteria set by the health plan. Its core function is to streamline access to specialized care for patients with chronic or complex conditions, reducing administrative barriers and ensuring continuity of treatment.
HOW TO OBTAIN A STANDING REFERRAL. For Members who are afflicted with life-threatening, degenerative or disabling diseases or conditions, a Standing Referral may be given to a specialist with clinical expertise in treating the disease or condition. In certain cases, a specialist may be designated to provide and coordinate the Member’s primary and specialty care. This Standing Referral must be obtained from the Member’s PCP. The referral provides the specialist with the ability to perform the treatment required for a specific episode of illness, and is valid for 365 days or until the end of the Agreement Year, whichever occurs first. The specialist may refer the patient for additional medical services such as durable medical equipment, education/training, and outpatient surgeries. Laboratory services must follow the PCP’s laboratory arrangement as indicated on the Member’s ID card. Please note that all Preauthorization guidelines will still apply. Designations of specialists to provide and coordinate the Member’s primary and specialty care must be requested in writing and shall be approved pursuant to a treatment plan approved by Keystone in consultation with the Member, the Member’s PCP and, as appropriate, the specialist.
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