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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.