Your Primary Care Provider (PCP) can manage your care, but there may come a time when you need to see a specialist for a specific medical condition. While the referral process might seem overwhelming, it’s simpler than you think! Most of the time, you can call or message your PCP to request a referral and have it within a few days or sooner.
What is a referral?
A referral is a written order from your PCP to see a specialist. All TRS-ActiveCare Primary or TRS-ActiveCare Primary+ participants must get a referral from your PCP before you can see a specialist.
Benefits of a referral
The referral process can be beneficial to you and your PCP. You'll:
- Save money. Your PCP may be able to manage your care and you won't need to pay more to see a specialist.
- Make sure the specialist has all the information they need. With the referral, your PCP will give the specialist your medical history, insurance information and other information they may need.
- Keep your PCP aware of all your health information.
- Get care from a colleague your PCP trusts. They'll work together to keep you healthy!
When do you need a referral?
Your PCP may decide you need to see a specialist to get better treatment for your health condition. For example, if your PCP finds a worrisome mole, they may want you to see a dermatologist for further assessment.
Here's what you should know about referrals:
- You don't need a referral for emergency care, annual well-woman visits, or in-network behavioral health specialists like a therapist, psychiatrist or other mental health professional.
- The specialist will decide how many visits you have in the referral period. So, you won't have to get a referral every time you visit your specialist.
- A specialist can't recommend you to another specialist; only your PCP can.
- Changing your PCP during a treatment period with a specialist may change your existing authorization.
Questions to ask your PCP about referrals
The way PCPs handle referrals varies. By asking specific questions, you can learn how yours will handle referrals and if their process will be a good fit for you.
Here are a few questions to ask your PCP about referrals:
- Can I ask for a specialist I found, or does your office need to recommend a specialist?
- Do I need to visit with you before you give a referral? If so, can it be done virtually or does it have to be in person?
- Can I request a referral over the phone?
- Do you have an online patient portal? If so, can I use it to make a referral request?
- Can you refer me to more than one specialist at a time?
- How many days do I typically need to wait between a request and a referral?
- Do you require a follow-up appointment after I see a specialist?
- How long does my referral last?
TRS-ActiveCare Resources
Provider Finder
If you don't already have a relationship with a PCP or want to find a new one, use Provider Finder® to find an in-network provider by location, specialty and more.
Questions about the referral process? Connect with a Personal Health Guide at 1-866-355-5999, or chat through the BCBSTX App, 24 hours a day, seven days a week.
Personal Health Guides
A Personal Health Guide can help you find a provider and even schedule an appointment. They're available 24/7 at 1-866-355-5999, or you can chat with them through the BCBSTX App.
