Referral to Specialists

Blue Cross and Blue Shield of Texas 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 Primary Care Provider (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 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 PCP after the emergency so follow-up care can be planned. This should be done for any emergency at home or away.

Applied Behavioral Analysis for Children with Autism Spectrum Disorder

Applied Behavioral Analysis (ABA) therapy is now a benefit for STAR members as a covered benefit through Texas Medicaid. ABA can help children with Autism Spectrum Disorder (ASD) develop improved function with their peers and caregivers. To qualify for ABA, your child must first have special testing to confirm their diagnosis of ASD.

ABA testing is more thorough than what most pediatricians can do as part of their practice. The testing must be performed by a specialist such as a developmental pediatrician, a neurologist, a psychiatrist, a licensed psychologist, or an Autism diagnosis team. Speak to your child’s pediatrician about getting a referral to one of these specialists.

Please check the ABA therapy Frequently Asked Questions for more information.

Go to Provider Finder® to search for and print a list of ABA providers in your area.

If you have more questions about ABA services, please call BCBSTX STAR Service Coordinator toll-free at 1-877-214-5630. Members with hearing or speech loss can call the TTY line at 711.

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Use our Provider Finder® to search for doctors and pharmacies near you.

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