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Referrals and Preapprovals

Referrals

A referral is when your primary care provider (PCP) sends you to another provider for care.

You will need a referral before getting these services:

  • Seeing a specialist
  • Going to a hospital for nonemergency
  • Getting certain medicines, tests, and services

You do not need a referral before getting these services:

  • Visits to your PCP
  • Emergency care
  • Well-woman checkups
  • Family planning
  • Immunization (shots)
  • Care services for mental health, alcohol, or substance abuse from a provider in the network

Preapprovals

You may need a preapproval, or an OK, from us before getting certain care. Your PCP will work with us to get the okay that you need.

You can find more about your benefits in your enrollee handbook. If you have questions or would like a copy of your handbook mailed to you, call Enrollee Services at 800-600-4441 (TTY 711).