Common use of SPECIALIST REFERRALS Clause in Contracts

SPECIALIST REFERRALS. You have two options if you need to see a Specialist. This option requires a referral from your PCP to see most types of Specialist. Your PCP will refer you to a Specialist or other appropriate Participating Provider in your Medical Group. With this option, you do not need a referral from your PCP to visit an Access+ Specialist in your Medical Group. You can self-refer to an Access+ Specialist for: • An examination or other consultation; and • In-office diagnostic procedures or treatment. You cannot self-refer to an Access+ Specialist for: • Allergy testing; • Endoscopic procedures; • Diagnostic and nuclear imaging, including CT, MRI, or bone density measurement; • Injectables, chemotherapy, or other infusion Drugs, other than vaccines and antibiotics; • Infertility services; • Inpatient services or any services that result in a facility charge, except for routine X-ray and laboratory services; or • Services for which the Medical Group routinely allows you to self-refer without authorization from your PCP. Blue Shield will provide the Subscriber and any enrolled Dependents with identification cards (ID cards). Only you can use your ID card to receive Benefits. Your ID card is important for accessing health care, so please keep it with you at all times. Temporary ID cards are available at xxxxxxxxxxxx.xxx or on the Blue Shield mobile app.

SPECIALIST REFERRALS. You have two options if you need to see a Specialist. This option requires a referral from your PCP to see most types of Specialist. Your PCP will refer you to a Specialist or other appropriate Participating Provider in your Medical Group. With this option, you do not need a referral from your PCP to visit an Access+ a Trio+ Specialist in your Medical Group. You can self-refer to an Access+ a Trio+ Specialist for: • An examination or other consultation; and • In-office diagnostic procedures or treatment. You cannot self-refer to an Access+ a Trio+ Specialist for: • Allergy testing; • Endoscopic procedures; • Diagnostic and nuclear imaging, including CT, MRI, or bone density measurement; • Injectables, chemotherapy, or other infusion Drugs, other than vaccines and antibiotics; • Infertility services; • Inpatient services or any services that result in a facility charge, except for routine X-ray and laboratory services; or • Services for which the Medical Group routinely allows you to self-refer without authorization from your PCP. Blue Shield will provide the Subscriber and any enrolled Dependents with identification cards (ID cards). Only you can use your ID card to receive Benefits. Your ID card is important for accessing health care, so please keep it with you at all times. Temporary ID cards are available at xxxxxxxxxxxx.xxx or on the Blue Shield mobile app.