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 | * The following article was archived on 09/30/2010.
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Reminder: members may receive OB/GYN services without a referral
Posted: 12/18/2008 | |
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| HMO/POS members receive direct access to any network obstetrical/gynecological (OB/GYN) specialist or subspecialist without a referral. Regardless of where the services are performed, no referrals are needed for preventive care visits, routine OB/GYN care, or problemrelated OB/GYN conditions.
Specialties and subspecialties not requiring referrals include, but are not limited to, the following:
- OB
- GYN (including urogynecologist)
- OB/GYN
- gynecologic oncologist
- reproductive endocrinologist/infertility specialist
- maternal fetal medicine/perinatologist
- midwife
Services no longer requiring referrals from primary care physicians (PCP) or OB/GYNs include, but are not limited to, the following:
- all antenatal screening and testing;
- fetal or maternal imaging;
- hysterosalpingogram/sonohysterogram.
You must continue to use the OB/GYN Referral Request Form for the following services:
- pelvic ultrasounds, abdominal X-rays, intravenous pyelograms (IVPs), and DEXA scans (these tests must be performed at the member’s capitated radiology site);
- initial consultations for HMO members for endocrinology, general surgery, genetics, GI, urology, pediatric cardiology, and fetal cardiovascular studies (visits beyond the initial consultation still require a PCP referral).
Please remind your patients about the change in referral requirements, and contact your Network Coordinator with any questions.
*This article was featured in the December 2008 edition of Partners in Health Update.
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