On the Sana First Health Plan (SFHP), a referral is required before receiving most care outside of Sana Care.
If you receive care that requires a referral without completing the referral process first, the claim will be denied and you'll be responsible for 100% of the cost.
If your claim was denied for a missing referral, what you should do next depends on whether you had a valid referral in place when you received care.
What to Do If Your Claim Was Denied with a Referral
If you completed the referral process with Sana Care prior to your appointment but your claim was still denied for a missing referral, this is usually caused by an administrative or billing mismatch. In those instances, just reach out to us for further assistance!
What to Do If Your Claim Was Denied without a Referral
If you received care that required a referral without completing the Sana Care referral process first, the claim will be denied.
You have the right to submit an appeal and ask Sana to review the circumstances surrounding your care.
How to File a Formal Appeal
If your claim was denied because care was received without a required referral, you have the right to file a formal appeal.
- Timeframe: You or your treating provider must submit a written appeal within 180 days of receiving your Explanation of Benefits (EOB).
- Required Documentation: Gather a copy of your EOB, relevant medical records from the visit, and a detailed letter explaining the clinical or administrative circumstances surrounding the visit.
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Submission: Submit your appeal packet via mail to the Appeals address listed at the bottom of your EOB.
- Sana Benefits - Attn: Appeals 3723 Greenville Ave STE 13463 Dallas, TX 75206
Submitting an appeal does not guarantee that the claim will be covered. Your appeal and supporting documentation will be reviewed to determine whether the original claim decision should be changed.
Can I Get a Referral After I've Already Received Care?
A Sana First referral should be completed before you receive care that requires one.
If you've already received care without the required referral, Sana Care cannot simply issue a referral afterward to replace the referral that was required before your visit.
Instead, you can submit an appeal asking Sana to review the circumstances surrounding the care and claim denial.
Have questions? We've got you covered.
- Log in to view account details.
- Search FAQs in our Help Center.
- Connect with Customer Support directly through the chat icon on most Sana pages or call us at (833) 726-2123 Monday through Friday, 7 AM to 7 PM Central.