Referrals to Specialists
HMO and EPA Members
Sometimes you may need a medical service beyond what your PCP can offer in their office. When specialty services are medically necessary, your PCP will refer you to a specialist. If you are an HMO member and want to see a particular specialist, you must first contact PCP. In most cases, your PCP will refer you to a specialist with the same hospital or PO/PHO affiliation. However, your PCP can refer to any affiliated specialist in the open delivery system. HMO members may not call a specialist and schedule an appointment on their own without prior contact with their PCP.
What is a referral?
Referrals are preauthorizations from your PCP for the delivery of a defined specialty service or consultation that is a covered benefit for a member.
Paperless referrals
Many HAP providers are now participating in a "paperless" referral system. This means you will not have a physical piece of paper to take to the specialist. As long as you have started the process with your PCP, all the information regarding specialty services has been put through the proper channel.
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