If I am in a “closed” HMO/POS plan, when is a referral from my PCP not required in the state of Georgia?

Question:

If I am in a “closed” HMO/POS plan, when is a referral from my PCP not required in the state of Georgia?

Answer:

  • A woman may refer herself directly to a network OB-GYN.
  • A member may go directly to a network dermatologist.
  • A member who seeks eye care for medical conditions only may go directly to a network ophthalmologist or optometrist. This self-referral is not for routine vision care.
  • Mental health care or substance abuse treatment may be obtained by calling the number on your insurance ID card.