A specialist is a doctor who specializes in taking care of a particular bodily system or disease. Cardiologists (heart care) and oncologists (cancer care) are two common types, but there are many more types of specialists.
Referrals play an important role in helping your PCP manage your care and coordinate the different care you may need so you get the highest level of benefits from your health plan. If you need specialty care, your PCP refers you to a specialist.
You do not have to bring a paper copy of the referral to the referred to doctor or facility. That doctor or facility can see this information online. However, if you’d like, you can ask your PCP to give you a copy, or you can sign in to print a copy of the referral confirmation.
Prior authorization means that Horizon BCBSNJ must approve certain specialty, ancillary, elective inpatient and other additional elective services before you receive them. Without prior authorization, you might get services that are not covered by your plan, leaving you responsible for the total cost of that care.
To find out if you need prior authorization for a specific service, use the Horizon Blue app or sign in.