Seeing a Specialist
If you think you need to see a specialist
A specialist is a Doctor that has been trained as an expert in certain diseases or areas of the body. For example, an orthopedic specialist treats broken bones, joints and other problems related to bones and the skeleton.
Your Primary Care Physician (PCP) will suggest a specialist when needed. He will give you a referral. This is a written order given to you to see a different doctor.
Self Referral Services
In some cases you may be able to seek treatment without a note from your primary care provider. You can find a list of these services under Referrals and Authorizations or you can call Enrollee Services at (202) 821-1100 or (855) 326-4831
When you must have a written approval
When you need special care, like a hospital admission or surgery, you need approval before you can get them. This is to be sure that you are getting the care you need and that is right for your condition. Your Doctor or Enrollee Services must be contacted.