Referrals to Specialists

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

A referral is required for cases that are difficult to manage or when care is beyond the primary care physician's (PCP's) scope of practice. Refer to the Referral for Specialty Consultation discussion for a summary of some of the services that may be referred to a specialist.

Health Net delegates the referral process to full and shared-risk participating physician groups (PPGs). Referrals to participating and non-participating specialists for members assigned to a capitated PPG are subject to any additional rules imposed by the PPG. PPGs may not impose referral or authorization requirements that conflict with the member's right to self-refer.