Referrals and Prior Authorizations

Referrals are required under the HealthSelect of Texas ® plan.

A referral is a written order from your primary care provider (PCP) for you to see a specialist. For most services, you need to get a referral before you can get medical care from anyone except your PCP. If you don't get a referral before you get services, you will get out-of-network benefits. In most cases, a referral is good for 12 months.

You do not need a referral for:

• Covered vision care, including routine and diagnostic eye exams
• OB/GYN visits
• Mental health counseling
• Chiropractic visits
• Occupational therapy and physical therapy
• Virtual Visits, urgent care centers and convenience care clinics

Prior Authorizations

Effective Sept. 1, 2024, HealthSelect SM medical prior authorization is no longer required.

Your providers may choose to ask Blue Cross and Blue Shield of Texas (BCBSTX) for a pre-service clinical review of your upcoming services to make sure they meet coverage guidelines and are medically necessary; however, this recommended clinical review is optional. If your in-network provider chooses not to request a review before providing your service, you will not be responsible for any charges determined to be not medically necessary. If you receive care from a non-network provider, you may be responsible for more of the cost.

You can see the status of your referrals and prior authorizations by logging in to your Blue Access for Members SM account.

• Log in to Blue Access for Members.
• Click on the "Coverage" tab, then select "Prior Authorizations and Referrals" from the drop-down
• Click on the "Status Details" link next to each item to view detailed information.

Continuity of Care

If you are currently receiving ongoing treatment from a provider who is leaving the HealthSelect network, you may be able to continue treatment with that provider temporarily. This is called continuity of care. To continue your care, certain eligibility guidelines need to be met. Fill out a Continuity of Care Request Form. You can submit the form by mail or fax to BCBSTX.

To find out if you qualify for continuity of care, BCBSTX may need to request medical information from your current provider(s). If you are approved for continuity of care, in-network benefits may be available for up to 90 days after your provider leaves the network.

Medical conditions that may be eligible for continuity of care benefits include:

• Pregnancy
• Treatment of a serious or complex condition
• Terminal illness