Referrals and preapprovals
For some services, you’ll need a referral from your primary care provider (PCP) before getting care.
You will need to see your PCP to get a referral before:
- Seeing 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 health care needs
Preapprovals for medicines
Some medicines need a preapproval, or an OK, from us before your doctor can prescribe them. Learn more
Call us at 1-800-600-4441 (TTY 711).