What are the procedures for obtaining referrals for specialists?

Health New England typically requires a referral from a primary care physician to see a specialist. This process generally involves several steps. First, it is advisable for a member to schedule an appointment with their primary care physician to discuss the need for a specialist. During this visit, the primary care physician will evaluate the member’s health concerns and determine if a referral is appropriate. If the physician deems it necessary, they will provide the member with a referral, which may include specific instructions or preferred specialists within the Health New England network. Members should ensure that the specialist they are referred to is within the Health New England provider network, as seeing an out-of-network specialist may result in higher out-of-pocket costs or denial of coverage in some cases. It is also important to check the specific terms of the member’s health plan, as there may be variations in referral procedures or requirements. For additional guidance on this process or to find a list of preferred specialists, members can visit the Health New England website.