CFHP does not require a referral to see a specialist. Some specialists and PCP offices require or prefer to have a “Referral.” You should ask your PCP to confirm with the specialist if a referral is needed from the PCP for you to be seen.
If the specialist is not in-network, CFHP will try to recruit the provider. A Letter of Agreement (LOA)/Single Case Agreement can be signed by the provider if needed. These LOA/Single Case Agreements can be for one or several visits and lengths of time.
CFHP needs authorization for some services before they are done. The provider will call CFHP to request the services. They will provide the information about your medical case. You should check with your provider to see if an authorization is needed. You should ask if they have the approval before the services are done.
Continuity of Care
1.Existing authorizations for acute care services (like physical, occupational, or speech therapy) will be honored for six months after November 1, 2016, until the authorization expires, or until the health plan conducts a new assessment.
2.Existing authorizations for long-term services and supports (like private duty nursing and personal care services) will be honored for six months after November 1, 2016 or until the health plan conducts a new assessment.
3.You may continue to see non-physician providers where you have an existing relationship with that provider, even if they are out of network and/or out of the Bexar Service Area, for up six (6) months after November 1, 2016.Authorization(s) for new services may be required depending on the service or procedure being performed.
4.You may continue to see physician and specialists where you have an existing relationship with that primary care or specialist physician, even if they are out of network and/or out of the Bexar Service Area, for up to twelve (12) months after November 1, 2016 without need for an authorization to pay the provider’s claim.