What Is a Referral?

A referral is when one provider sends a patient to another provider, usually a specialist, for diagnosis and treatment. Before you see a specialist or another provider, talk to your primary care provider.

A referral is good only until the end of the period okayed by Community Health Plan of Washington.

If you have a complicated or serious medical problem, you have the right to a referral that lasts for a longer period of time than a regular referral. This is called an extended (or standing) referral. An extended referral, like a regular referral, is good only until the end of the period okayed by Community Health Plan.

To get a referral, you must talk to your PCP. Your PCP will tell us:

  • Which provider the PCP refers you to.
  • The length of time and number of visits your PCP says you may use the provider's services.

When Do I Need to Get a Referral?

Except in emergency care, if you get services or treatment from a provider outside our network without first getting a referral from your PCP, the Plan will not pay for it.

To see a list of participating providers and specialists, including their location, languages spoken, and availability:

  • Search providers online.
  • Phone the Community Health Plan customer service team at 1-800-440-1561, Monday through Friday from 8:00 am to 5:00 pm, or email customercare@chpw.org. If you are hearing or speech impaired, please call TTY Relay: Dial 7-1-1.

You do not need your PCP's referral for:

  • Emergency services, which also do not require a prior authorization.
  • Routine and preventive women's health care services by providers in the Community Health Plan of Washington network, regardless of diagnoses.
  • Family planning services and sexually transmitted disease screening and treatment services provided at family planning facilities such as Planned Parenthood or your local Public Health Department.
  • Immunizations provided by your local Public Health Department.
  • HIV screening and tuberculosis screening and follow-up at your local Public Health Department.

For more information about your benefits:

  • See Your Medical Benefits and Prescription Drug Services.
  • Contact the Community Health Plan customer service team at 1-800-440-1561, Monday through Friday from 8:00 am to 5:00 pm, or email customercare@chpw.org. If you are hearing or speech impaired, please call TTY Relay: Dial 7-1-1.