Self-referrals are services you can arrange for yourself without first calling your primary care practitioner (PCP). You must see an AmeriHealth Caritas Northeast network provider for these self-referred services. Services that do not need a referral or prior authorization are:
- Prenatal visits.
- Routine obstetric (OB) care.
- Routine gynecological (GYN) care.
- Routine mammograms, with a prescription.
- Routine family planning services. **
- Routine dental services, if you are eligible for dental services under the Medical Assistance program.*
- Routine eye exams.*
- Prescription eyeglasses for members under age 21.
- Tobacco cessation counseling sessions.**
- First visit with a chiropractor.
- First 24 visits for outpatient physical, occupational, and speech therapy.
- Emergency services. **
- DME purchases costing less than $750 that are covered by the Medical Assistance program and with a prescription (see Prior Authorization).
* You may need to get a referral or prior authorization from your PCP for some specialty care services. There may also be some limitations for self-referrals. If you are not sure if you need a referral from your PCP for a service, ask your PCP or call 1-855-809-9200.
** This self-referred service may be provided by a provider not in the AmeriHealth Caritas Northeast network.