How to Get Specialty Care
Here are answers to some common questions about seeing a specialist.
How do I know if I need to see a specialist?
If you have a new health concern, the best place to start is with your primary care doctor (also called your personal physician). Primary care doctors are trained to care for a wide range of health issues. They can help you determine if you should see a specialist for evaluation or treatment.
Do I need a referral to see a specialist?
At Group Health Medical Centers, you can see many specialists without a referral from your primary care doctor. Sometimes you may be asked to check with your primary care doctor first, even if your health plan does not require a referral. That’s because in certain specialties and sub-specialties, appointments slots are kept for patients with urgent needs. Your primary care doctor can help you determine the best steps for your health care.
To see specialists who contract with Group Health (meaning they don’t practice at a Group Health Medical Centers location), you will usually need a referral.
Check your health plan or call Customer Service if you have questions about whether you need a referral.
I have a Medicare Advantage plan. Do I need a referral?
You can see certain specialists at Group Health clinics without a referral from your primary care doctor or another specialist. Customer service representatives can help you find the right specialist on your plan.
If you'd like to see a specialist who does not practice at Group Health Medical Centers, you will need a referral.
I am on Managed Medicaid or Basic Health. Do I need a referral?
Yes, you will need to get a referral from your Group Health primary care provider in order to see a specialist. You will also need to be seen by either a Group Health specialist or a specialist in Molina’s network.
If you use a specialist outside of Group Health, please refer to Molina’s Provider Directory for the specialists in your area.
Can I choose which specialist I see at Group Health?
Yes, you can choose which specialist you want to see, just as you can choose your personal physician. If you are seeing a specialist and for some reason aren’t comfortable or satisfied with your care, you can change specialists.
Use our Provider Directory to find specialists in your health plan, both at Group Health clinics and those who practice at non-Group Health locations. Also, you can see a list of Group Health specialists on the pages for most specialties.
Is my specialty appointment covered by my health plan?
If your health plan covers primary care at Group Health Medical Centers, your visit to a specialist at a Group Health Medical Centers clinic is covered — just like it is for seeing your primary care doctor. Depending on your health plan, you may be responsible for a portion of the cost, such as a copayment, or coinsurance.
If you see a specialist who doesn’t work at a Group Health Medical Centers location, your visit is covered only if your health plan includes contracted providers.
Check your health plan to see if you need a referral to a contracted specialist and if you have a copay or coinsurance. If you’re not sure about coverage, call Customer Service.
How do I make an appointment with a specialist?
You can call the specialist’s clinic for an appointment. Or, if you are registered with MyGroupHealth for Members, you can log in to our secure member site and make an appointment online with a specialist at a Group Health location.
Use the Provider Directory to find specialists included in your health plan. If you need help finding a specialist or have questions about coverage, contact Customer Service.