Referral procedures are determined by each medical group and do vary ask your medical group to explain the procedure they use. Referrals are usually made within your PCP's medical group. You may need to obtain a written referral indicating the medical reason for the referral, the number of visits required and the extent of treatment. If you receive a copy of the written referral, it is important that you present this to the specialist upon your first visit. The HMOs of Blue Cross and Blue Shield of Illinois do not make medical decisions.
Utilization management is a process designed to evaluate the appropriateness of medical care.
UM procedures may include the review of referrals, planned surgical procedures and inpatient treatment so that care can be rendered by appropriate health care providers and facilities. To add eligible dependents, see your employer for an Application and Policy Change form and instructions. Submit the form to your employer within 31 days of your life-event change, along with any other documentation your employer requires. It s easy to change your PCP or medical group. To change to another PCP in the same medical group as your current PCP, simply call the medical group to inform them of your decision.