Skip to Main content

Self-referrals

Self-referrals are services you can arrange for yourself without first calling your primary care practitioner (PCP). You must see an AmeriHealth Caritas Northeast network provider for these self-referred services. Services that do not need a referral or prior authorization are:

  • Prenatal visits.
  • Routine obstetric (OB) care.
  • Routine gynecological (GYN) care.
  • Routine mammograms, with a prescription.
  • Routine family planning services. **
  • Routine dental services, if you are eligible for dental services under the Medical Assistance program.*
  • Routine eye exams.*
  • Prescription eyeglasses for members under age 21.
  • Tobacco cessation counseling sessions.**
  • First visit with a chiropractor.
  • First 24 visits for outpatient physical, occupational, and speech therapy.
  • Emergency services. **
  • DME purchases costing less than $750 that are covered by the Medical Assistance program and with a prescription (see Prior Authorization).

* You may need to get a referral or prior authorization from your PCP for some specialty care services. There may also be some limitations for self-referrals. If you are not sure if you need a referral from your PCP for a service, ask your PCP or call 1-855-809-9200.

** This self-referred service may be provided by a provider not in the AmeriHealth Caritas Northeast network.