Do I need a referral with a BCN AdvantageSM plan?
Who is this for?
BCN Advantage members who want to know if they need a referral to see a specialist. And if so, how to get one.
BCN Advantage doesn’t require a referral for you to make an appointment with an in-network specialist. Some in-network specialists may need to confirm with your primary care physician that you need specialty care. Your PCP is the best resource for coordinating your care and can help you find an in-network specialist.
When you're a member of one of our HMO-POS or HMO plans, you get the convenience of having one doctor who looks out for your health and coordinates your care.
Whether you have a bad cough, foot pain, or even a suspicious mole, see your primary care physician first. They might be able to give you the care you need. If not, they can refer you to a trusted specialist in your network, like a podiatrist or a dermatologist.
How do referrals work if I need one?
Generally, referrals are no longer required. However, if you choose to get a referral from your primary care physician, referrals are good for up to a year.
Some referrals need to be approved by Blue Care Network before you can see the specialist. This is called a prior authorization. In this case, your primary care physician will let you know when your authorization is approved. Or we’ll send you a letter in the mail.
In most cases, you won’t need separate referrals each time you see the same specialist. But you do need to coordinate your appointments with your primary care physician. And if your specialist wants you to see another specialist, you’ll need to get another referral from your primary care physician.
What if I change doctors?
If you get a new primary care physician and you’re seeing specialists that require a referral, you’ll need to get new referrals from your new doctor.
Call us if you have questions
We’re here for you if you have questions. Call the number on the back of your Blues ID card and we’ll get you the help you need.
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