Does a member still need a referral from their PCP to see a specialist?

Outside of the products that provide members with the self referral option (EPO, PPO, POS) members must always contact their PCP first.

  • After the initial visit, the specialist can continue to see the member without a follow-up order from the PCP.
  • If the specialist is referring the member to another provider, the member should be redirected back to the PCP to initiate the referral. The specialist is responsible for communicating with the PCP about the recommended treatment/referral plan and when appropriate referring the member back to the PCP.

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