We've Got You Covered
When you choose the Western Health Advantage HMO plan, you are getting integrated care from a team of doctors. First, you’ll select a primary care physician - also known as your PCP. Your PCP is the doctor who will coordinate your care. And, when you need specialty care, your PCP refers you to a specialist.
Yet, unlike other HMOs, Western Health Advantage doesn’t get in the way of the choices you make for care. Our Advantage Referral Program allows your PCP to refer you to specialists not only within a PCP’s medical group, but across any of the medical groups in our network. It’s all about giving you choice and flexibility so you get the care you need.
Humboldt County Locations
Providence St. Joseph Hospital Eureka
2700 Dolbeer Sreet
Eureka, CA 95501
707-445-8121
Providence Redwood Memorial Hospital
3300 Renner Drive
Fortuna, CA 95540
707-725-3361
You will find conveniently located hospitals as well as full-service care centers that offer a wide array of services under one roof.
WHA's Advantage Referral
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:
- Dignity Health's Mercy Medical Group
- Dignity Health's Woodland Clinic
- Hill Physicians Medical Group – Sacramento and Solano
- Meritage Medical Network
- NorthBay Healthcare
- Providence (formerly St. Joseph Health)
Can I use Advantage Referral?
Members who are assigned to a PCP from one of the following medical groups are eligible for the Advantage Referral program:
- Dignity Health's Mercy Medical Group
- Dignity Health's Woodland Clinic
- Hill Physicians Medical Group – Sacramento and Solano
- Meritage Medical Network
- NorthBay Healthcare
- Providence (formerly St. Joseph Health)
How do I use Advantage Referral?
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.
How does the referral work?
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.
Is prior authorization required?
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.