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Referrals & Preapprovals

Before you get certain services, you may need a referral from your PCP or preapproval (called prior authorization) from Amerigroup. Otherwise we may not pay for the service. To get a referral or preapproval, talk to your primary care provider (PCP).

Referrals

Yield TriangleYou’ll need a referral before you go to a:

  • Specialist
  • Hospital for nonemergency care

Green CheckYou don’t need a referral to get:

  • Emergency care (for life threatening conditions or severe pain)
  • Behavioral health or substance use disorder services
  • Women’s health services like a breast or pelvic exam
  • Care from an OB/GYN or midwife
  • Family planning services
  • Testing or treatment for HIV, AIDS or other sexually transmitted diseases (STDs)
  • Tuberculosis screening or follow up care
  • Immunizations (shots)

Preapprovals (prior authorizations)

Yield TriangleYou’ll need a preapproval before you get:

  • Surgery
  • Care from a doctor who isn’t in our plan
  • Medical supplies (including durable medical equipment)
  • Drugs not included in your pharmacy benefits
  • Prescription drugs not listed on our preferred drug list (PDL)
  • Brand-name drugs that have a generic available
  • Any drug amount that is more than the plan allows
Have questions? Call Member Services at 1-800-600-4441 (TTY 711).