We no longer require participating physicians to notify us of referrals to in-network specialty-care providers. However, this is only an administrative change; it does not eliminate the referral requirement.
- Depending on the member's benefit plan, referrals from PCPs may still be required for specialty-care services to be covered at the highest benefit level.
- PCPs are responsible for providing a written referral to the specialty-care physician, and for noting the referral in the patient's medical record.
- Specialty-care providers also must note the referral in the patient's record.
If your patient has an HMO or network plan, the PCP must provide a referral for specialty care.
POS plans also require PCP referrals for specialty-care services from participating providers. Members may receive services from non-participating providers without a referral from their PCP. However, there is a strong incentive for members who obtain a referral and remain within the provider network-they'll enjoy the highest benefit levels for covered services and lowest out-of-pocket expenses.
Referrals are never needed in Open Access, PPO and Indemnity plans. Members may visit any doctor for primary or specialty care.
All Cigna HealthCare plans have adopted an "open access" policy for women's health care. Referrals are not needed for visits to Cigna HealthCare participating OB/GYNs for covered obstetrical or gynecological services.
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