Referrals and preapprovals

Referrals

Your primary care provider (PCP) can take care of many of your needs, but you may need care from another type of provider. If you do, your PCP may send you to a specialist. This is called a referral.

If you want to go to a doctor who isn’t your PCP, talk to your PCP first. If needed, they will refer you to a specialist in your 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.

You don’t need preapproval for:

• Primary care services
• Women’s health care services
• Family planning services
• Children’s screening services
• Services provided at local health departments
• Emergency care
• Urgent care
• Some behavioral health and substance use disorder services