No Referral Required
Some health care services provided by specialists do not require a referral from a primary care provider. Members may schedule self-referred services from participating providers themselves. PCPs do not need to arrange or approve these services for members as long as any applicable benefit limits have not been exhausted. These include the following:
- Certified Nurse Midwife (CNM) services.
- Certified Nurse Practitioner (CNP) services.
- Chiropractic care (within benefit limits).
- Dental care (excluding oral surgery and orthodontics). See Dental Handbook.
- Services to treat an emergency.
- Family planning services (Planned Parenthood).
- Laboratory services (must be ordered by a participating provider).
- Podiatric care.
- Psychiatric care at community mental health centers only.
- Psychological care (from private practitioners or at community mental health centers).
- Care at public health clinics.
- Care at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
- Radiology services (must be ordered by a participating provider).
- Routine eye exams (at participating vision centers).
- Speech and hearing services.
- Care from obstetricians and gynecologists.
- Care at urgent care centers after hours.
Please note that members may go to nonparticipating providers for:
- Emergency care.
- Care at community mental health centers.
- Family planning services provided at Qualified Family Planning Providers (Planned Parenthood).
- Care at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).
- Care at Ohio Department of Alcohol and Drug Addiction Services facilities that are Medicaid providers.