Do I need a referral for authorization?

Your PCP will give you a referral to send you to a specialist if you need one. A specialist is a doctor who has extra education in one area of medicine. Your PCP will work with you to choose a specialist. Your PCP’s office can help you set up a time to see the specialist.

Other services that may require a referral include in-office procedures, X-rays, lab work and specialty services. 

Your PCP may give you a form to take to the specialist. The specialist will fill out the form and send it back to your PCP. The specialist will treat you for as long as he or she thinks you need treatment.

If you have a health problem that needs special medical care for a long time, you may need a standing referral. This means you can see the same specialist more than once without getting a referral each time.

If you have trouble getting a standing referral or want a copy of the HPSM referral policy, call 1-800-750-4776 (TTY 1-800-735-2929 or dial 7-1-1).

You do not need a referral for:

• PCP visits
• Ob/Gyn visits
• Urgent or emergency care visits
• Family planning (to learn more, call California Family Planning Information and Referral Service at 1-800-942-1054)
• HIV testing and counseling (only minors 12 years or older)
• Treatment for sexually transmitted infections (only minors 12 years or older)
• Acupuncture
• Chiropractic services
• Podiatry services

Minors also do not need a referral for:

• Outpatient mental health for:
  
  • Sexual or physical abuse
    
  • When you may hurt yourself or others
    
• Pregnancy care
  
• Sexual assault care
  
• Drug and alcohol abuse treatment