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.
Services That Require a Referral
You may see any doctor in our network without a referral. However, some doctors may request a referral from your PCP. We will still cover medically necessary services provided by an in-network provider without a referral. You may be referred to another provider if:
- Your PCP does not provide the care or service you need
- You need to see a specialist
You could be referred for medical tests, treatments or other services. Referrals for certain care or services do not require our approval. These include:
- Routine diagnostic tests
- Lab tests
- Basic X-ray services
- Some routine care provided in a doctor’s office (not in a hospital)
- Mental health or substance abuse services