Starting January 1, 2007, you don’t need a referral to see any In-Plan specialist. Up until then you needed a referral from your primary care physician (PCP) for:

• Dermatology
• Allergy-related services
• Rehabilitative services (physical, occupational and speech therapy)
• Cardiac rehabilitation

Now you can set up an appointment with any In-Plan specialist without getting a referral. Your PCP is still the best person to coordinate your care. He or she will discuss treatment options and help decide where you can get the services you need. Also, some specialists may require a doctor's order before they will see you (just like your pharmacist requires a prescription).  Your PCP can provide that order. For example, before treating you, a neurologist may want to obtain your PCP's opinion. Or a physical therapist may want your PCP to write a treatment order.  However, by removing the referral requirement we have taken away an additional step - your doctor no longer has to notify HNE.

Just remember, this change only applies to In-Plan specialty referrals. You still need Prior Approval for certain services and Out-of-Plan care. Services that need Prior Approval are listed in your Member Agreement. Any benefit limits and cost sharing requirements (copayments, deductibles, coinsurance) still apply as well.