- Quick Links
- Your Benefits
- Need Specifics?
Referrals and Authorizations
Referrals
A Referral is a special permission that is normally given by your Primary Care Provider (PCP) for you to see a Specialist. Examples of Specialists are Cardiologists, Dermatologists and Allergists. As an NHP member, you can see any specialist in the NHP Provider Network without a referral if those specialty services are covered under your plan. We urge you to coordinate all of your specialty care with your PCP first and ask that any specialty provider you see also notifies your primary care site with the results of your visit. Your PCP should be informed about all the specialists that you are seeing and medications you are taking, so that he or she can make sure you are getting the care that's right for you.
Your PCP is always the best person to help you coordinate your healthcare. Before making your appointment with an NHP Network Specialist, talk with your PCP about the situation. Your PCP can help you consider options and help decide where you can get the services you need. It is your responsibility to make sure that the specialist you wish to see is part of NHP's network. You may search our provider directory or call the NHP Member Service Center at 800-462-5449 (TTY 800-655-1761).
If your PCP is affiliated with Harvard Vanguard Medical Associates(HVMA)
If your PCP is affiliated with Harvard Vanguard Medical Associates(HVMA), you are required to obtain a referral if you choose to receive medical care from an NHP specialist who is not affiliated with HVMA.
Authorization
An Authorization is a special approval by NHP for payment of certain services. Not all services require Authorization. When an Authorization is needed, it must be given before you receive the service in order for NHP to cover it. Your PCP or the Specialist treating you will request an Authorization if it is necessary.
Examples of services requiring Authorization from NHP are physical therapy, speech therapy, surgical procedures, planned admissions, and inpatient psychiatric care. NHP gives Authorizations as soon as possible. NHP must also authorize your use of any provider who is not part of NHP's Network. In order to make sure you receive consistent care, there are some conditions when NHP will provide authorization for you to see a provider that is not part of NHP's Network. You can call the NHP Member Service Center for help in understanding if your condition qualifies you to see a Provider out of the NHP Network. If you receive services from a provider who is not part of NHP's Network and you did not have Authorization from NHP first, you may have to pay for the service.
