Referrals and prior authorizations
Your employees want to get the care they need when they need it. We make it easy.
HMO members
Referrals
With HAP, specialty office visits don’t require referrals from a primary care physician. But in some cases, the specialist may require a referral from a member’s PCP. Many specialists are booked out months in advance and may only accept patients whose PCP believes they need specialty care.
Prior authorization
Before you go to the doctor or have services performed, it's important to understand our approval process. There are common treatments and procedures that require approval before you get them. This is also known as prior authorization.
If your service requires prior authorization, your doctor will take care of it on your behalf.
Example:
When Mary visits the ear, nose and throat doctor for the first time, she pays her specialist office copay. After her consultation, the ENT recommends a sinus surgery for Mary. Before she has the surgery, the ENT’s office must get prior authorization from HAP to make sure the service is covered and that it’s medically necessary.
For hospital stays
For inpatient hospital stays, the member’s doctor will get prior authorization from HAP. Emergency room visits don’t require prior authorization. Members must notify HAP within 48 hours of the emergency admission.
PPO members
Members with a PPO plan don’t need to worry about referrals. With a PPO plan, they have the flexibility to seek care from doctors in and out of the network. But they might pay more if they choose a doctor outside of our network.