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Under the Independence Provider Agreement, for HMO and POS members, except
in an emergency, providers are
required to refer members only to participating providers for covered services.
This includes, but is not limited to,
ancillary services such as laboratory (i.e., members and/or their lab
specimens) and radiology.
Reminder: Specialists should ensure a referral is on file
before rendering services. Services obtained without a
referral, when one is required, will not be covered by Independence.
If a participating provider is not available for referral or direction of
the member, the ordering provider must obtain
preapproval from Independence before referring/directing the member to a
non-participating provider.
If a provider is referring a member to a non-participating provider or
provides/requests non-covered services to or for a
member, the provider must inform the member in advance, in writing, of the
following:
- a list of the services to be provided;
- Independence will not pay for or be liable for the listed non-covered
services;
- the member will be financially responsible for such services.
You can access the Independence Member Consent for Financial
Responsibility for Unreferred/Non-covered Services
Form on our website. By signing this form, the member agrees to pay for
non-covered services
specified on the form. The form must be completed and signed before services
are provided.
If a member presents without a referral, the provider should request that
the member completes a financial
responsibility form.
If a provider does not comply with the requirements
as outlined above, the ordering provider is required to hold the
member harmless. The ordering provider will be responsible for any and all
costs to the member and shall reimburse
the member for such costs or be subject to claims offset by Independence for
such costs.
If you have any questions, please contact your Network Coordinator.