What happens if I receive medical care from a network physician without first getting a referral from my primary care physician?
In order to receive in-plan benefits for a service, the member has to receive a referral from his/her primary care physician. As noted above, the only exception to this requirement is that female members may receive two office visits annually from participating OB/GYN physicians without a referral from the primary care physician. Any services received from a network provider in which the primary care physician did not first provide a referral will be covered under the out-of-plan benefit.
Related Questions
- What happens if I receive medical care from a network physician without first getting a referral from my primary care physician?
- What happens if my Primary Care Physician (PCP) or Medical Group leaves the Anthem Blue Cross HMO network?
- Is a referral from a Primary Care Physician necessary to begin treatment?
