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What to know about Referrals
This guide provides a detailed explanation of how referrals help you stay healthy, when you need one, and how they work.
Do CarePartners of Connecticut members need a referral?
Members in a CarePartners of Connecticut plan have a PCP who helps ensure they get the right care. Beginning January 1, 2020 members will not need a referral to see an in-network specialist. This makes it easier to see a specialist while still getting the benefits of a PCP who coordinates your care. A referral would still be required to see an out-of-network specialist.
What is a referral?
In an HMO plan, your Primary Care Provider (PCP) oversees your care. This includes providing day-to-day care and treatment for common illnesses in addition to “referring” you to a specialist for specialized care that your PCP can’t provide such as dermatology or physical therapy.
How does a referral help you?
Generally, in an HMO plan your doctor is responsible for coordinating or overseeing your care including any care you get from a specialist. By issuing your referrals, your PCP is able to keep track of the care you receive and ensure you get the right care. For example, your PCP will coordinate with specialists to make sure you don’t receive duplicate services or unnecessary tests, which could save you money.
Do you need a referral slip?
You don’t need an actual referral slip. Your PCP will send the specialist the referral information. If you arrive at your specialist appointment and your referral isn’t there, ask the specialist’s office to call your PCP and have the referral sent while you wait.
What if you need to see other specialists?
If a specialist refers you to another specialist, always check with your PCP before making the appointment. As your care coordinator, only your PCP can issue your referrals.