Referrals and prior authorizations
You want to get the care you need when you need it. We make it easy.
HMO members
Referrals
Need to see a specialist? No problem. With HAP, specialty office visits don’t require referrals from your primary care physician (PCP). But in some cases, the specialist you see may require a referral from your 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 (ENT) 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 will need to verify if the surgery is covered and if prior authorization for the surgery is needed from HAP.
For hospital stays
For inpatient hospital stays, your doctor will get prior authorization from HAP. Emergency room visits don’t require prior authorization. The hospital will notify HAP within 48 hours of the emergency admission.
PPO members
You don’t need to worry about referrals. With a PPO plan, you have the flexibility to seek care from doctors in and out of the network. But remember, you might pay more if you choose a doctor outside of our network.