Referrals to Specialists
Full Plan benefits apply for covered services that are provided by in-network specialists with a referral from your Primary Care Provider (PCP). Services provided by out-of-network specialists need a PCP's referral and Plan authorization.
Referrals help everyone concerned:
- The specialist knows why you were referred,
- The specialist knows that your PCP has authorized the care, and
- You know assured that the bill for your visit with the specialist will be paid
Please remember that it's your responsibility to get referrals before receiving specialty care.
Referrals are valid for only those services or diagnoses indicated. All referrals are valid for one year, or for the number of visits indicated, whichever comes first. It's important that you keep track of the number of visits authorized and how many times you have seen the specialist to whom you've been referred. And please remember that:
- If additional visits are necessary in addition to those authorized by your referral, it's your responsibility to obtain another referral for those additional visits.
- If the specialist wants to refer you to another specialist or for other services, you need authorization from your PCP.