2023 Referral List

Do I need a referral?

If you're on a PPO plan, you do not need a referral.

If you're on an HMO plan in one of the following areas, you do not need a referral:

Alabama
Arizona - Yavapai, Coconino, Pima counties only
North Carolina
Ohio
Pennsylvania
South Carolina
Tennessee

For all other plans, use the list below to determine which services require a referral.

Note: For members with an HMO plan and an Advocate Physician Partners (APP) PCP, APP will manage referrals and authorizations.

You need a referral for:

A
Allergist (Immunologist)

C
Cardiologist (not required for C-SNP plans In Arizona)

Cardiovascular surgeon

Colon and rectal surgeon

D
Dermatologist (Florida members: only for visit 6 and beyond)

E
Endocrinologist (not required for C-SNP plans in Arizona or Texas)

G
Gastroenterologist

General surgeon

Genetic counselor

Gynecologic oncologist

H
Hand surgeon

Hematologist

Hepatologist

Hospice and palliative medicine specialist

I
Infectious disease specialist

Interventional cardiologist

M
Medical geneticist

N
Nephrologist (not required for C-SNP plans In Arizona or Texas)

Neurological surgeon

Neurologist

O
Occupational medicine specialist

Oncologist

Oral surgeon (Maxillofacial surgeon)

Orthopedic surgeon

Otolaryngologist (Ear, nose, and throat specialist)

P
Pain management specialist

Physiatrist

Plastic surgeon

Pulmonologist (not required for C-SNP plans In Arizona)

R
Radiation oncologist

Reproductive endocrinologist

Rheumatologist

S
Sleep disorders specialist

Spinal cord injury specialist

Sports medicine specialist

Surgeon

T
Thoracic surgeon

U
Urologist

V
Vascular surgeon

You don't need a referral for:

A
Acupuncturist

Addiction psychiatrist

Anesthesiologist

Audiologist

C
Cardiac electrophysiologist

Certified diabetes educator (CDE)

Certified nurse-midwife

Certified nursing assistant (CNA)

Certified professional midwife

Certified registered nurse anesthetist (CRNA)

Chiropractor

Critical care medicine specialist

D
Dentist

Dialysis

E
Emergency medicine specialist

F
Family medicine physician

Forensic pathologist

G
General practitioner

Geriatric medicine specialist

Gynecologist

H
Hospitalist

I
Internist

L
Licensed mental health counselor

Licensed nurse (LPN or LVN)

N
Nurse practitioner (NP)

O
Obstetrician

Occupational therapist

Ophthalmologist

Optician

Optometrist

P
Pathologist

Perinatologist

Pharmacist

Physical therapist

Physician assistant (PA)

Podiatrist

Psychiatric nurse

Psychiatrist

Psychologist

R
Radiologic technologist

Radiologist

Recreational therapist

Registered dietitian (RD)

Registered nurse (RN)

Respiratory therapist (RT)

S
Social worker

Speech therapist