For some Medicaid services, you’ll need a referral from your primary care provider (PCP) before getting care.
You’ll need to get a referral from your PCP before:
Meeting with a specialist.
Going to a hospital for nonemergency care.
Getting certain medicines, tests, and services.
For most services, you'll go to your PCP or another provider in our plan. But there are some services we'll pay for, even if you get them from a provider who's not in our plan. These are called self-referral services.
You don’t need a referral from your PCP for:
Women’s healthcare services
Maternal depression screening
Family planning services
Behavioral health services (mental health and substance use)
Dental care from a LIBERTY Dental plan dentist (select plans)
Vision care from a plan provider (select plans)
HIV and STI screenings
Smoking cessation services
A preapproval is when your doctor asks us to approve a service before you receive it. Your PCP will work with us to get the preapprovals you need.
Your PCP will need to send in a preapproval for:
Some ambulatory surgery
Certain chemotherapy not covered by NYRx
Durable medical equipment
Growth hormone evaluation
Digital hearing aids
Hyperbaric oxygen therapy
Non-emergent fixed wing transportation
Obstetrical services (except family planning services)
Prosthetics and orthotics
Some physician-administered drugs not covered by NYRx
Not connected with or endorsed by the U.S. Government or the federal Medicare program.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent or insurance company.
This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, please contact your agent or the health plan.
Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Call our Customer Service number, (TTY: 711).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711).
注意：如 果您使用非英語的其他語言，您可以免費獲得語言援助服務。請致電聯絡客戶服務部（聽語 障用戶請致電：711）。
