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For some services, you’ll need a referral from your primary care provider (PCP) before getting care. When your PCP is unable to give you care or treatment, he or she may send you to another provider, such as a specialist. Your PCP will sign a referral form and send you to an Anthem network provider. The referral form tells you and the specialist what kind of health care you need. Be sure to take the referral form with you when you go to the specialist.

You’ll need a referral from your PCP before:

• Seeing a specialist
• Going to a hospital for non-emergency care
• Getting medicine your PCP can’t give you

Self-referral services

For most services, you’ll go to your PCP or another provider in our network. But there are some services that we’ll pay for, even if you get them from a provider who’s not in our network. These are called self-referral services and include:

• Behavioral health care
• Care provided by your Anthem network PCP’s nurse or doctor’s assistant
• Emergency care
• Eye exams from an Anthem network eye care provider (optometrist)
• Family planning services from any qualified family planning provider
• Healthy Kids visits to an Anthem network provider
• Prenatal care from an Anthem network obstetrician or certified nurse-midwife
• Yearly exams from an Anthem network OB/GYN