PCP Referrals

Referral to a Specialty Care Provider

Your primary care practitioner will provide a referral to a specialty care provider when additional specialized care is needed. Ambetter will not limit any primary care practitioner from referring to practitioners not in the Ambetter network when treatment is medically necessary, and no Ambetter network provider is available to provide the care needed. This policy includes referrals to other parts of the state or country as needed. The primary care practitioner will work with Ambetter on identifying referral providers. Ambetter is responsible for providing all members written notice of any services that will not be covered by the health plan benefits when referred to an out-of-network provider. You as a member would not be responsible for paying for services not covered due to any referrals to an out-of-network practitioner with Ambetter unless you received an official letter from Ambetter alerting you that Ambetter will not be responsible for future payments to the out-of-network practitioner.