Referrals

Self-referrals

Self-referrals are services you can set up for yourself without first calling your PCP. You must see an AmeriHealth Caritas Pennsylvania (PA) Community HealthChoices (CHC) network provider for these self-referred services. Services that do NOT need a referral or prior authorization are:

• Prenatal visits.
• Routine obstetric (OB) care.
• Routine gynecological (GYN) care.
• Routine mammograms, with a prescription.
• Routine family planning services **.
• Routine dental services.
• Routine eye exams*.
• Tobacco cessation counseling sessions**.
• First visit with a chiropractor.
• First 24 visits for outpatient physical, occupational and speech therapy.
• Emergency services**.

PCP referrals

When your PCP thinks you need to see a specialist, he or she will refer you to a specialist who can best help you with your health care needs.  To see the specialist, your PCP may need to write you a prescription.  Talk with your PCP before seeing a specialist.

In some cases, Participants with a life-threatening, degenerative, or disabling disease or condition, or Participants with other special needs may be able to have a “standing referral.” A standing referral means you do not have to see your PCP each time you need to see a specialist. Call Participant Services for more information.

* You may need to get  prior authorization from your PCP for some specialty care services. There may also be some limitations for self-referrals.

** This self-referred service may be provided by a provider not in the AmeriHealth Caritas Pennsylvania Community HealthChoices network.