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
You’ll need a referral before you go to a:
- Specialist
- Hospital for nonemergency care
You 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)
You’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
