Getting Services Covered

Services Requiring A Referral

Your PCP will need to make a referral for you to get certain services. These include:

• Services that your PCP does not perform
• Specialist visits and specialty care at an office or free-standing clinic require a referral

What Is A Referral?

A referral is when your PCP sends you to another doctor or facility in our plan to get care. Most often, it will be a specialist. The specialist has extra training in a certain area of medicine. Your PCP will let the specialist or facility know that they are sending you there for treatment and share your medical records with the provider.

Services from Providers Not in Our Network

There may be times when the health care you need is not available using a provider who is a part of our network. If you need care from someone not on our provider list, your PCP will work with the health plan to arrange care for you. Note: Prior authorization may be needed.