For some services, you'll need a referral from your primary care provider (PCP) before getting care.
You may need to get a referral from your PCP before:
- Meeting with a specialist.
- Going to a hospital for nonemergency care.
For most services, you'll go to your PCP or another provider in our plan. But there are some services that we'll pay for, even if you get them from a provider who's not in our plan. These are called self-referral services.
You do not need a referral from your PCP for:
- Family planning services
- Pregnancy services
- Emergency services
- School-based health center services
- Adult dental care (age 21 and over)
- Behavioral health and substance use disorder services
- Certain providers for children with special healthcare needs
For more information on the referral process, check your member handbook or live chat with a representative.