Blue Cross and Blue Shield of Texas (BCBSTX) allows members with special health care needs to have direct access to the right specialists for their conditions and identified needs. This includes a standing referral to a specialty doctor, or having a specialist as a PCP if needed.
Mental Health/Substance Abuse services do not need an OK from your PCP when you are not in the hospital, but you do have to see a Magellan provider.
Some PCPs and OB/GYNs offer family planning. You do not need an OK from your PCP to get family planning help. Members may use any qualified family planning clinic, certified nurse midwife or provider. The provider does not need to be part of BCBSTX.
If you need help finding a specialty doctor, mental health/substance abuse services or an OB/GYN provider, call the Customer Advocate Department at 1-888-657-6061 or TTY 711.
You do not need a referral to get emergency services. You should call your child’s PCP after the emergency so follow-up care can be planned. This should be done for any emergency at home or away.