When you need a referral

Talk with your primary care provider (PCP) before you make an appointment with another provider. You may need a referral from your PCP when you receive certain services outside your plan’s network. A PCP referral lets us know you can get care from a different provider.

Services that may require a referral include: 

• Specialist visits
• Outpatient hospital visits 
• Surgical day care 
• Your first evaluation for speech, occupational or physical therapy 

See in-network providers

You should not be billed for any of these services if you get them from an in-network provider. In-network means you receive care within your plan’s network of providers.

Services that do not require referrals

You do not need referrals for outpatient behavioral health services, emergency care services, post-stabilization care services, OB/GYN services or family-planning services from any MassHealth-contracted, family-planning services provider.

Questions?

Call our member services team at 888-257-1985 (TTY: 711)