GHP Family Provider Manual - Geisinger Health Plan

DIRECT ACCESS AND SELF-REFERRALThe following services do not require a referral from the PCP:• Vision• Dental care• Obstetrical and Gynecological (OB/GYN) services• Chiropractic services may be accessed in accordance with the process set forth in Medical AssistanceBulletin 15-07-01: http://services.dpw.state.pa.us/olddpw/bulletinsearch.aspx?BulletinId=4092• Physical therapy services may be accessed in accordance with the amended Physical Therapy Act (63P.S. 1301 et seq.)Please Note: To be self-referred, the Member must obtain these self-referred services from GHP Family’s Network.Family Planning Services do not require Prior Authorization or referral. Members may access Family Planning Servicesfrom any qualified provider. Family Planning Services include, but are not limited to:• Health Education• Counseling necessary to make an informed choice about contraceptive methods• Pregnancy testing and breast and cervical cancer screening services• Contraceptive supplies such as oral birth control pills, diaphragms, foams, creams, jellies, condoms (male andfemale), Norplant, injectables, intrauterine devices, and other family planning procedures• Diagnostic screens, biopsies, cauterizations, cultures, and assessmentsMembers have direct access to OB/GYN services and have the right to select their own OB/GYN provider; thisincludes nurse midwives participating in GHP Family’s Network. They can obtain maternity and gynecologicalcare without prior approval from a PCP. This includes:• Selecting a provider to give an annual well-woman gynecological visit• Primary and preventive gynecology care• PAP smear and referrals for diagnostic testing related to maternity and gynecological care, and MedicallyNecessary follow-up care• Perinatal and Postpartum maternity careIn situations where a new pregnant Member is already receiving care from an out-of-Network OB-GYN SCP at the timeof enrollment, the Member may continue to receive services from that SCP throughout the pregnancy and postpartumcare related to the delivery.SUBSTANCE ABUSE AND BEHAVIORAL HEALTH REFERRALSMany behavioral health disorders such as depression, anxiety and substance abuse often occur in Members who presentfor medical care. PCPs and all non-behavioral health practitioners are encouraged to recommend behavioral healthservices to Members when deemed appropriate. Substance abuse and behavioral health services are available to allGHP Family Members through the Member’s local county mental health office or that office’s sub-contracted provider.PCP must inform the Member or the County Children and Youth Agency representative how to access these mentalhealth services and coordinate access to these services, when necessary. To refer GHP Family Members for theseservices, please reference the behavioral health contact information table in the Contact Information section of thismanual for county, provider, and contact details. Members may also self-refer.For state wide information visit: http://pa.networkofcare.orgTo search for a Community Care Behavioral Health Organization provider visit: http://www.ccbh.com22