01Niche tool
Referrals that close the loop
A referral is not finished when it is sent. It is finished when the specialist's letter is in your child's chart and one of our clinicians has read it. Here is exactly how ours run.
- Who submits authorizationOur referral coordinator, before booking
- What travels with itGrowth, labs, imaging and the question
- Loop reviewOpen referrals chased weekly
- After the specialistWe take routine care back
02
Six steps, and who owns each one
Most referral failures are handoff failures. Naming an owner for every step is how we stop them.
- 01
We decide together that a specialist helps
Not every problem needs one. When we refer, we tell you the specific question we are asking the specialist to answer, so the visit is not a fishing trip.
You and your clinician
- 02
Prior authorization, before you are booked
Our referral coordinator checks whether your plan requires authorization and submits it. We do this before you are given an appointment, so nobody turns up to a visit that will not be covered.
Referral coordinator
- 03
Records go with the referral, not after it
Growth charts, relevant labs, imaging reports, medication history and our actual clinical question are sent with the referral. Specialists see children faster when the packet is complete.
Referral coordinator
- 04
You get the appointment and the prep
We call you with the date, the address, what to bring and whether your child needs to fast or hold a medication. Anything that needs to be stopped before testing is written down.
Front desk
- 05
The loop gets closed
A referral is not finished until the specialist's letter is in your child's chart and one of our clinicians has read it. Open referrals are reviewed weekly and chased.
Clinical team
- 06
We take the care back
For most conditions the specialist sets the plan and we run it: refills, monitoring labs, school forms and the next review. You should not need a specialist appointment for a routine refill.
Your clinician
03
Where we refer, and what the wait really is
Typical central Iowa waits. They move with the season and with how complete the referral packet is.
| Specialty | What we refer for | Typical wait | Prior authorization |
|---|---|---|---|
| Pediatric ENT | Recurrent otitis media, obstructive sleep apnea, tongue-tie release | 3 to 5 weeks | Usually required |
| Pediatric cardiology | Murmur with red-flag features, chest pain with exercise, syncope | 2 to 4 weeks | Usually required |
| Pediatric gastroenterology | Failure to thrive, chronic constipation, suspected celiac disease | 4 to 8 weeks | Usually required |
| Pediatric allergy and immunology | Multiple food allergies, poorly controlled asthma, immunotherapy | 4 to 6 weeks | Varies by plan |
| Developmental-behavioral pediatrics | Formal autism assessment, complex developmental delay | 3 to 6 months | Usually required |
| Pediatric orthopedics | Scoliosis curve over 20 degrees, fracture follow-up, limp of unknown cause | 1 to 3 weeks | Varies by plan |
| Pediatric dermatology | Severe eczema, changing pigmented lesions, hemangioma management | 6 to 10 weeks | Varies by plan |
| Child psychology and therapy | Anxiety, mood, behaviour, trauma, feeding disorders | 6 to 12 weeks | Often required |
Waits are sample figures for this demonstration site and vary by insurer, urgency and centre.
General information, not medical advice. It is not tailored to your child and it does not replace a visit.
04
What we tell you before the appointment
The prep instructions are where referrals usually go wrong, so we put them in writing.
- Whether your child needs to fast, and from what time
- Any medication to hold, and for how long before the test
- What to bring: inhalers in the bag, a sleep diary, school reports, previous imaging discs
- How long to allow, because some first visits run two hours
- Whether siblings can come, which for a developmental assessment usually means no
- Who to call if your child gets worse while you are waiting
05
Questions about referrals
Many plans require the insurer to agree in advance that a specialist visit is covered. We submit it before you are given an appointment, so that nobody turns up to a visit the plan will not pay for. Timelines vary by plan and can take a few days.
Some plans allow it and some do not. Even where it is allowed, a referral from us means the specialist receives the growth charts, labs and the actual clinical question, which usually gets your child seen sooner and makes the visit more useful.
Sometimes. We can mark a referral urgent where the clinical picture justifies it, ask to be placed on a cancellation list, or refer to a second centre. Tell us if your child gets worse while you are waiting, because that changes the urgency.
Usually us. For most conditions the specialist sets the plan and we run it: refills, monitoring labs, school forms and reviews. You should not need a specialist appointment for a routine refill.
We chase it. Open referrals are reviewed weekly and a referral is not marked complete until the letter is in the chart and a clinician has read it. If you have seen the specialist and heard nothing from us in three weeks, call the front desk.
Ask us before you go looking
If you are wondering whether your child needs a specialist, bring it to a visit. Half the time the answer is no, and the other half we can shorten the wait.