Referred Specialist Clause Samples

The 'Referred Specialist' clause defines the process and conditions under which a party may engage an external expert or specialist for specific tasks or advice related to the agreement. Typically, this clause outlines who can request a specialist, the criteria for selection, and how the costs will be allocated between the parties. By establishing clear procedures for involving third-party expertise, the clause helps ensure that complex or technical issues are addressed appropriately, reducing disputes and ensuring informed decision-making.
Referred Specialist a Professional Provider who provides Covered Specialist Services within his or her specialty upon Referral from a Primary Care Physician. In the event there is no Participating Provider to provide these services, Referral to a Non-Participating Provider will be arranged by a Member’s Primary Care Physician with Preauthorization by the HMO. See Section ACC - Access to Primary, Specialist and Hospital Care Network for procedures for obtaining Preauthorization for use of a Non-Participating Provider. For the following outpatient services, the Referred Specialist is the Member’s Primary Care Physician's Designated Provider: (a) certain rehabilitation Therapy Services (other than Speech Therapy); (b) podiatry services, if the Member is age nineteen (19) or older; and (c) certain diagnostic radiology services, if the Member is age five (5) or older. A Member’s Primary Care Physician will provide a Referral to the Designated Provider for these services.
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