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Important Information Regarding
Personal Choice/AHC Referrals
When a Referral IS Needed
A Primary Care Physician is required to make a referral in the following
- A Primary Care Physician is required to make a referral in the following
- Sending a Primary Care patient to any other doctor for treatment including
diagnostic testing by a cardiologist.
- If the “referred to” specialist needs to send the patient
to another physician.
- Treatment/surgery by an OB/GYN when the visit exceeds the maximum
number (usually two) of self-referrals allowed by a member’s specific
group benefit plan. Pregnancy requires a separate
- Emergency treatment – The patient must notify the physician
within 48 hours.
When a Referral is NOT Needed
Referral notification is not required in these situations:
- Treatment rendered by a Primary Care Physician.
- Services by laboratories, pathologists, radiologists and anesthesiologists
when ordered by the PCP or specialist for whom there is a referral. EXCEPTION! A
referral is required to an anesthesiologist for an epidural when used
in pain management.
- Additional physicians treating or consulting during an in-network
- Physical therapy ordered by the PCP or a specialist for whom there
- Ambulance services: EXCEPTION! Uniroyal
contracts require a referral.
Referrals to specialists require notification within 72