How HMOs Work

How It Works

Referrals

When your PCP determines that you need to see a specialist, he or she will give you a referral form. You must get a referral form before you see a specialist. For UCHP, you will also need Health Plan approval if the specialist is not a UCPG specialist. If you schedule an appointment or get care without a referral from your PCP, you must pay for the services you received.

If your PCP refers you to a specialist:

Make a copy of the referral for your records. You may need one later to prove you should not be billed for the specialist’s services.

Go to the specialist within the designated time period. If you go later, you have to pay the cost of the visit yourself.

Go to the specialist only for the designated number of visits. If you go more often than that, you have to pay the cost of the additional visits.

Contact your PCP if you need to have the designated time period changed or the designated number of visits extended.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.