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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 a specialist. 

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

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

Here's what you should know about referrals

  • Only TRS-ActiveCare Primary and TRS-ActiveCare Primary+ participants need a referral from their PCP to see a specialist.
  • You don’t need a referral for emergency care, annual well-woman visits, or in-network behavioral health specialists.
  • You don’t have to ask your PCP for a referral every time you visit a specialist. The specialist will decide 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.

You can also download two fliers to help you navigate referral requests:

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.