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The Importance Of Referrals In Primary Care

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Based upon our review, you filed a grievance because you stated that you reached out to your plan’s customer service department and you spoke with several representatives regarding if you need a referral and you felt like they did not know what exactly what is the policy.

During our investigation, our record does show where you called and spoke with a representative on January 7, 2015 and March 18, 2015 regarding a referral. In 2015, you will need a “soft” referral which means that your primary care physician should note in the chart you are requesting to see a specialist, but nothing is required to be sent to your plan unless it is a service that needs an authorization. Referrals from a primary care physician are not required for emergency

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