When enrolled with Centivo, you must select a PCP–a Primary Care Physician. Think of this PCP as the quarterback to all of your care. They should be in the know about everything that is going on with you.

In the event your PCP can’t treat you for a specific ailment, they might refer you to see a specialist.  The doctor will give you the name of the specific individual they want you to see. This also means your PCP will log into their internal portal and create an electronic referral for you to see this new specialist for this specific ailment.  You cannot self-refer to a specialist. Your PCP must initiate this on your behalf. If you do not have a referral in place, there will be a financial penalty to you–which means you’ll need to pay more for that particular visit or service.

There is a process that you must follow for your referral. Please click here to read more about the Centivo referral process.

Referral tips

• For specialist care, you’ll need a referral from your primary care doctor.
• Referrals are automatically approved and good for one year.
• If you can’t get an appointment with the specialist you were referred to, your referral will work for another doctor of the same specialty.
• Be sure you see the referral in the Centivo app prior to making an appointment.

Benefits of referrals to members

• • This simple referral process means you will:
    • Get the right care for your needs with your primary care doctor as your partner, guiding your care.
    • Avoid unnecessary tests or unexpected out-of-network procedures – keeping your costs low.
  • The referral process also ensures your primary care doctor is aware of other care and treatments you receive. You get better care when it’s coordinated by your doctor.
  • Relying on your primary care doctor to coordinate your care saves you time. Your doctor can lead you to the right specialist without hours of searching online, scouring reviews and trying to figure out which one best suits your needs.

Referral Exceptions

You don’t need a referral for the following services:

• Urgent or emergency care
• OB/GYN
• Behavioral health
• Rehabilitation services such as physical therapy
• Chiropractic care
• Acupuncture
• Labs, X-rays and other covered tests.*

* Note: These services can be ordered by your designated primary care doctor, a specialist for which you had a referral or an in-network provider for which referrals aren’t required (e.g., an OB/GYN). Pre-certification may be required depending on the diagnostic test.