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Need to see a network specialist?

Be sure it’s covered first. Find out what approvals your plan may require.

Imagine that your primary doctor (also called a primary care provider or PCP) says it’s time for you to see a surgeon. What’s your next move?

Ask for recommendations? Make an appointment? Those are good ideas. But in some cases, you or your doctor may need to make a different call first — to your health plan.

Why? Some plans require referrals or prior authorization before you:

  • See another provider — even if he or she is in your network
  • Have certain services
  • Get some medications

We want you to get the care you need. Without a referral or prior authorization, you may have trouble getting care — or your plan may not pay for it.

How referrals work

Some plans require a note from your primary doctor before you visit a specialist, such as a surgeon or therapist. This may be the case if your plan requires you to have a primary doctor.

Without this referral, you may not be able to make an appointment — or your health insurance may not pay the claim.

How prior authorization works

In some cases, your health plan needs to approve medicines or services — such as a hospital stay — before you get them.

Without this approval, you could be responsible for the full cost.

It’s easy to be sure

To find out if your plan requires referrals or prior authorization, you can:

  • Go online. Log in to a new window)®. On your home page, choose “Look up My Benefits.”
  • Make a call. To talk with one of our Customer Care representatives, call the member number listed on your health plan ID card. You’ll be connected to someone who can help you.

What to do next

If you need a referral or prior authorization, talk with your primary doctor. He or she can help you find out what approvals are needed for your care — and help you find a specialist in your network.

To learn more about the network and referrals, watch our “Avoiding Cost Surprises” video(Opens a new window)

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