What is the difference between a REFERRAL and a PRIOR AUTHORIZATION?

What is the difference between a REFERRAL and a PRIOR AUTHORIZATION? Under what circumstances does BCBSTX require a REFERRAL? Under what circumstances does BCBSTX require a PRIOR AUTHORIZATION?

 

  • Hello, A referral is when your primary care doctor directs you to another provider, usually a specialist, to receive treatment. Prior authorization is when your doctor contacts us to request approval for a service before it is performed.

    You can contact customer service to verify if a particular service requires prior authorization. ~ Kayla
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