59A-12.008. Referral Procedures

Each HMO or PHC must have in place: (1) A system to facilitate referral of subscribers to contracted or non-contracted physician and hospital providers; and, in the case of non-contracted providers, include a procedure for prior authorization and written notification regarding such referral to the subscriber. (2) A means for notifying the subscribers of the referral system, including the procedures for the subscribers to obtain a second medical opinion. Such notification shall be clearly stated in either the subscriber contract, member handbook or other written communication.