How do I get a referral?
Your PCP will refer you to a specialist if needed. A referral to a specialist must be approved by your primary care provider. If you have any problems getting a referral or problems with the referral process, you should call the PHC Member Services Department.
A Specialist is a medical doctor who has had extra education in a special area of medicine. Your primary care provider (PCP) will refer you to a specialist as needed. A referral to a specialist must be approved by your PCP, but does not need to be approved by PHC. Your PCP will notify PHC of the specialist referral by using a form called Referral Authorization Form (RAF). If you have any questions about the referral process, you can call our Member Services Department at (800) 863-4155.
There are some services that do not require a referral from your primary care doctor. Those services are:
Family Planning Services - You do not need a referral for family planning services. You can go to any Medi-Cal provider that is willing to provide these services. Examples of family planning services are:
• Appointments for birth control, including emergency contraception
• Pregnancy testing and counseling
• Testing and treatment for sexually transmitted disease
• Tubal ligation
You can get more information about how to receive these services by calling our Member Services Department or your primary care provider. You can also call the Department of Health Services, Office of Family Planning at (800) 942-1054. The office of Family Planning provides information about family planning services, consultation and referral to family planning clinics.
Prenatal Care - You do not need a referral from your primary care doctor to receive prenatal care from an OB/GYN.
If you are pregnant, you should call and speak to one of our Case Managers about our case management program for pregnant women. For more information about this program please call (800) 809-1350.