Common use of Provider Referrals Clause in Contracts

Provider Referrals. Except as permitted by the Member’s Evidence of Coverage, Provider shall not refer a Blue Shield Member to other health care providers without an advance authorization from Blue Shield or its delegate or otherwise in accordance with the utilization management procedures established by Blue Shield and as described in the Provider Manual. Without limiting the foregoing, if this Agreement applies to Blue Shield commercial HMO, EPO and/or Medicare Advantage Benefit Programs, Provider shall refer commercial HMO, EPO and/or Medicare Advantage Members only to health care providers who/that have entered into agreements with Blue Shield to provide Covered Services to Members for the provision of Covered Services. This provision shall not apply in the event a Member requires Emergency Services.