If a Health Plan member requires specialty care or services not available through our in-plan network of providers, then his/her physician may refer them to one of The Health Plan's participating tertiary providers.
Specialty referrals to non-participating providers will not be authorized by The Health Plan if the required services can be provided by our tertiary network. All Tertiary services will be referred to participating tertiary facilities unless, of course, the facility is unable to provide a particular service, at which time, The Health Plan may give prior approval for another facility.
Remember, out-of-area referrals to both participating and non-participating facilities must be preauthorized by The Health Plan Medical Department and will not be approved after the fact except for true documented emergencies.
If you have any questions about Tertiary facilities or any other subject, please call us.