When you sign up for an HMO, your first step is to pick a Medical Group.  Then you will choose a primary care provider in that group to manage your care.

Your PCP will make sure you get the care you need, even when you see another doctor or go to the hospital. When you have a health issue, you’ll first go to your PCP. If the PCP thinks you need to see a specialist, they’ll arrange it for you by submitting your referral request

The PCP will:

• Refer you to a specialist in your HMO medical group network
• Work with your medical group to get a referral approved
• Monitor what is diagnosed and what care you get from the specialist
• Turn in any additional referrals needed, such as for other specialists, lab work or hospital stays.

Three quick things you’ll want to make sure happen:

• All specialist visits require your PCP to work with your medical group for a referral. Don’t go without one.
• The referral must be for a specialist in that medical group. You’ll only be referred outside the medical group if there isn’t that type of specialist in the group.
• Check on the status of your referral: You may contact your medical group directly or your PCP's office to check if a referral has been approved. If the specialist requests additional tests or procedures, confirm if these services were included in the original referral. If not, a new referral will be required from your PCP.

It’s your right to ask questions to make sure your doctors are using your HMO the right way. If you don’t have a referral or if you have tests that aren’t a covered benefit, your HMO may not cover the costs for you.   

If you are getting ongoing treatment for a health issue, your PCP may put in a request for a standing referral. That way you can see your specialist as often as needed without having to request a new referral approval for each visit. 

You can get more information about your HMO health plan at any time. Just log in to or sign up for your secure member account online or through the BCBSIL App. Download it in English or Spanish from Apple App Store  or Google Play.