Referrals and preapprovals

Referrals

You may need to see your PCP before:

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

   You do not need a referral for these services:

• Emergency care
• Well-woman checkups or prenatal care from a women’s health doctor (OB/GYN) in our plan
• Family planning services from a provider in our plan
• Fee-for-Service (FFS) services that are not covered by Amerigroup
• Dental care from a LIBERTY Dental plan dentist
• Vision care from a Superior Vision plan provider
• Screening or testing for sexually transmitted diseases
• Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services from a provider in our plan

Preapprovals

You may need preapproval for certain services. Preapproval is when your doctor asks us to approve a service before you receive it. Your PCP will work with us to get the approval you need.

Your PCP will need preapproval for:

• Most surgeries including some outpatient surgeries
• All elective and routine inpatient services and admissions
• Experimental and investigational treatments
• Chiropractic services
• Most mental health/substance abuse (behavioral health) services, including psychological testing (except routine outpatient and emergency services)
• Certain medicines
• Certain durable medical equipment (DME) including prosthetics and orthotics
• Gastroenterology procedures including upper endoscopy and procedures related to bariatric surgery
• Digital hearing aids
• Home health services
• Hospice services
• Rehabilitation therapy (physical, occupational, respiratory and speech)
• Sleep studies
• Managed long‐term services and supports
• Out‐of‐area or out‐of‐plan care except in cases of emergency
• Advanced imaging (MRAs, MRIs, CT, CTA scans)
• Some pain management testing and procedures