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.