A few quick ways to identify if your EmblemHealth member needs a referral

EmblemHealth offers a wide range of health plans. For many EmblemHealth members, referrals are not needed from their PCP before receiving care from a specialist.  Still, we know that figuring out which plans require a referral may be confusing.  Watch the two-minute video below that shows your practice how to find out if a member’s plan requires a referral.

During the COVID-19 State of Emergency, all Medicare Advantage members will not need referrals.


Update: Effective December 1, 2020, SOMOS-managed members do not need referrals to see specialists.
Retroactive to Dec. 1, 2020, the referral requirement for SOMOS-managed members has been eliminated for participating EmblemHealth providers. Specialists’ claims with dates of service on or after Dec. 1 will not deny for a missing referral.

How do I find which plans need referrals?