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WHA’s Advantage Referral Program provides members with access to specialists from the following medical groups, expanding access to specialty care outside of their Primary Care Physician’s (PCP's) medical group:
Members who are assigned to a PCP from one of the following medical groups are eligible for the Advantage Referral program:
While your PCP will treat most of your health care needs, if your PCP determines that you require specialty care, you may request to be referred to any of the specialists who participate in the Advantage Referral program. You can use our online provider search or call Member Services for a list of participating specialists.
Note: If you receive care from a WHA network specialist prior to receiving a referral, you may be liable for the cost of those services.
Your doctor will send a written referral to your medical group’s Utilization Management department. A referral takes five days to complete for routine requests and 72 hours for an expedited request. Once the referral is processed you will receive notification with details of your referral.
No, Advantage Referrals do not require prior authorizations (pre-approval) since your PCP has established medical necessity by requesting the services of a specialist.
OB/GYN services for women and annual eye exams (when covered on your plan) do not require a PCP referral or prior authorization as long as the specialist participates in Advantage Referral.
If you have questions about WHA's Advantage Referral, call Member Services at 916.563.2250 or 888.563.2250. The team is available Monday through Friday 8 a.m. to 6 p.m. (excluding holidays). You may also email a question to memberservices@westernhealth.com.