How do HMO referrals work in a BCN AdvantageSM plan?

Who is this for?

Learn more about your BCN Advantage plan.

If you have a BCN Advantage plan, this information will tell you how to get a referral from your primary care physician to see other doctors.

When you're a member of one of our HMO-POS or HMO plans, you get the convenience of having one doctor who looks out for your health and coordinates your care.

Whether you have a bad cough, foot pain, or a suspicious mole, you’ll go see your primary care physician first. They might be able to give you the care you need. If not, they’ll refer you to a trusted specialist in your network, like a podiatrist or a dermatologist.

Tip: Women don’t need a referral to see an OB/GYN for Pap smears and annual well-woman visits. But you'll need to make sure you see an OB/GYN in your plan's network.

How referrals work

Most referrals from your primary care physician are good for up to a year.

Some referrals need to be approved by Blue Care Network before you can see the specialist. This is called a plan authorization. In this case, your primary care physician will let you know when your authorization is approved. Or we’ll send you a letter in the mail.

In most cases, you won’t need separate referrals each time you see the same specialist. But you do need to coordinate your appointments with your primary care physician. And if your specialist wants you to see another specialist, you’ll need to get another referral from your primary care physician.

What if I change doctors?

If you get a new primary care physician and you’re seeing specialists, you’ll need to get new referrals from your new doctor.

Call us if you have questions

We’re here for you if you have questions about referrals or any problems. Call the number on the back of your Blues ID card and we’ll get you the help you need.