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Specialist referrals from your Primary Care Provider

If you have TRS-ActiveCare Primary or TRS-ActiveCare Primary+, you do need a referral to see most specialists. However you don't need a referral for: 

  • emergency care
  • OB-GYN appointments, including annual well-woman exams
  • in-network mental health specialists
  • dermatologist visits
  • physical therapist visits
  • eye exams (both routine and diagnostic) with an in-network optometrist or ophthalmologist

A referral is a written order from your PCP for you to see a specialist. All participants with TRS-ActiveCare Primary or TRS-ActiveCare Primary+  must get a referral from their PCP before they can see most specialists. However, the referrals process isn't as complicated as you may think!

If you have TRS-ActiveCare HD or TRS-ActiveCare 2, you don't need a referral to see a specialist.

What you should know about referrals

  • You don’t have to ask your PCP for a referral every time you visit a specialist.
  • The specialist decides how many visits you have in the referral period.
  • A specialist can’t recommend you to another specialist; only your PCP can.
  • Changing your PCP during a treatment period with a specialist may change your existing authorization.

Questions to ask your PCP about referrals

The way PCPs handle referrals varies. By asking specific questions, you can learn how they handle referrals and if their process will be a good fit for you. Here are a few questions to ask your PCP about referrals.

  • Can I ask for a specialist I found or does your office need to recommend a specialist?
  • Do I need to visit with you before you give a referral? If so, can it be done virtually or does it have to be  in-person?
  • Can I request a referral over the phone?
  • Do you have an online patient portal? If so, can I use it to make a referral request?
  • Can you refer me to more than one specialist at a time?
  • How many days do I typically need to wait between a request and a referral?
  • Do you require a follow-up appointment after I see a specialist?
  • How long does my referral last?

Find Care

If you don’t already have a relationship with a PCP or want to find a new one, use Provider Finder® to find an in-network provider by location, specialty and more. 

Questions about the referral process? Connect with a Personal Health Guide at 1-866-355-5999, or chat through the BCBSTX App, 24 hours a day, seven days a week.