In most cases, your primary care physician manages your health care. If you need to see a specialist, your primary care physician will refer you to a network provider. The specialist is often affiliated with your primary care physician's hospital or medical group.
It is important that you obtain a referral from your primary care physician before you go for your visit. Otherwise, you may have to pay all costs associated with the appointment. If the specialist you were referred to wants you to see another provider, contact your primary care physician to get a referral for any other visits.
Services that Do Not Require a Referral
- Behavioral Health outpatient office visits
- Emergency medical care
- Ophthalmologist/Optometrist for routine eye exams only (HMO plan requires a referral for a diagnostic or sick visit)
POS and POS Plus Members
POS and POS Plus members have the flexibility to seek care without a referral and to see providers not in the HUGHP network. If you use your out-of-network benefits your out-of-pocket costs will be higher. Learn more