Clinic Location

7250 France Ave S.
Suite 410
Edina, Minnesota 55435     
Get Directions & Map
Phone:(952) 831-1551
Fax: (952) 831-0725
CustomerService@FAFPEdina.com

Referral Guidelines

When do I need a referral?

For any patients that have a health plan that requires a referral, a referral is needed for ANY non ER service received outside of your primary clinic. A referral to a specialist covers claims from that specialist only. Separate referrals may be needed for hospitals, radiology, physical therapy, etc.

Why do some health plan Customer Service representatives state "All you need is a referral from our PCC and you can go?"

Under managed care HMO, each primary care clinic belongs to a care system. Each care system has their designated network of specialty providers. For you to have your highest benefit, it is a clinic policy to refer to an in network provider whenever possible. Some plans have no benefit without a referral. Please contact your health plan Customer Service for those benefit options.

Referrals are authorizations from your primary physician for specialty services received outside of your primary care clinic, in or out of network. Only the physician has the authority to approve or deny a referral request because of medical necessity, network, etc. Some health plans will not authorize an out of network referral from your physician. Those services would require a PRIOR authorization by the health plan PRIOR to having the service

Do I need a referral if I have an emergency admit to the hospital, in or out of area?

No, referrals are not required for ER admits. However, out of area benefits might change; contact your health plan Customer Service.

Do I need a referral if I need to be seen out of area?

It is clinic policy to refer to in network providers whenever possible. Out of area providers are not generally health plan contracted. Contact your health plan Customer Service for self referral, out of area benefits.

My child is away at college and needs to see a doctor. Do I need a referral?

It is clinic policy to refer to in network providers whenever possible. Out of area providers are not generally health plan contracted. Contact your health plan Customer Service for self referral, out of area benefits.

What is a care system (network)?

A care system is an organized team of health care professionals including primary care clinics, associated specialty care providers, hospitals and allied health care professionals who can deliver the full range of health care services for their patients.

Referral Policy

France Avenue Family Physicians (FAFP) has ongoing relationships with many specialty providers and facilities. If we, as your primary care clinic, cannot offer a specific type of service, a referral will be generated if approved by your provider. It is your responsibility to contact the Referral Coordinator at least 48 hours prior to your appointment at 952-831-1133 or customerservice@fafpedina.com.

Under a managed care system, each primary care clinic belongs to a care system. Each care system has their designated network of health care professionals including, primary care clinics, associated specialty care providers, hospitals, and allied health care professionals, who can deliver the full range of health care services for their patients. FAFP is contracted with two separate networks, Fairview Physician Associates (FPA) and Minnesota Healthcare Network (MHN). For you to have your highest benefit and reduce your out of pocket costs, you will be referred to an in-network provider. Referrals outside of the network will not be authorized.

Only the physician has the authority to approve or deny a referral request because of medical necessity, network, etc. If the first specialist refers you to another specialist or for another procedure, YOU must call the Referral Coordinator at FAFP to obtain authorization for that service. The testing or services of the second provider are not automatically included in the referral to the first specialist. The following insurance plans are under managed care and may require a referral:

MHN
  • Medica Elect
FPA
  • Blue Plus
  • U Care
  • Patient Choice (Choice Plus)
  • Preferred One Administrative Services
  • Preferred One Community Health Plan
  • Medica Essentials
It is the patient's responsibility to call and obtain a referral. No retro-referrals will be authorized.

Please contact your health plan Customer Service for any benefit questions. Our Referral Coordinator is here to assist you with any questions you may have. Call or e-mail any questions to:
952-831-1133