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PCP Referrals

When your PCP sends you to see a specialist, this is called a "referral." In most cases, you will need to get a referral from your PCP to see a specialist. It may take a couple of days for your PCP to get the referral to the specialist. Always check with your PCP before going to see a specialist. For a list of services that do not need a referral, please see Self Referrals.

Remember, there is a difference between a referral and a prescription. Examples:

  • You would get a referral when you need to go to a specialist or outpatient facility. Your PCP will give you the referral.
  • A prescription can come from any of your doctors or a Nurse Practitioner. You would need a prescription for things like medicine, equipment or special medical tests.

In some cases, members with a life threatening, degenerative, or disabling disease or condition, or members with other special needs may be able to have a "standing referral." A standing referral means you do not have to see your PCP each time you need to see a specialist. Call 1-855-809-9200 for more information.