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Referrals and prior authorizations

Referrals and prior authorizations

A referral means you need your doctor’s approval to get a service. Your doctor will take care of any referrals you need. Some services require prior authorization from Clear Health Alliance. This means that your doctor must ask us to approve those services before you get them.

You do not need prior authorization for:

  • Preventive and screening services, including well-child checkups for children and annual health checkups for adults
  • Family planning services
  • Office and free standing laboratory tests at labs meeting CLIA guidelines
  • Emergency transportation services
  • Urgent or emergent care at participating Urgent Care Centers or any emergency room
  • County Health Departments (CHD)
  • Federally Qualified Health Centers
  • Rural Health Clinics and federally-funded migrant health centers when providing:
    • Vaccines (except pneumonia and shingles for adults)
    • STD diagnosis or treatment
    • Rabies diagnosis or immunization
    • School health services and urgent services

For services not listed here, prior authorization may be required. Call Member Services at 1-844-406-2398 (TTY 711), or check with your primary care doctor to find out more.