Approvals and Referrals

What services require prior approval or a referral?

Prior approval and referrals depend on your plan. To learn more, log in to Blue Connect and read member's frequently asked questions (FAQs).

How do I get prior approval or a referral?

Prior approval and referrals depend on your plan. To learn more, log in to Blue Connect and read member's frequently asked questions (FAQs).

What if I don't get prior approval or a referral?

If you do not receive prior approval or certification for services (except emergency care or maternity), your claim may be denied, paid at a lower benefit, or a penalty may be applied.

When do I need a referral from my primary care provider (PCP)?

You do not need to get a referral from your primary care provider to receive covered services from a participating specialist. However, some participating specialists may require a new patient introduction from your treating doctor.