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Referrals

Do I need a referral from my UCLA primary care physician to see a specialist at UCLA?
I am enrolled with the UCLA Medical Group as my primary care medical group. Do I need a referral to see a specialist at UCLA?
Can I refer myself for women's health services?
I am NOT a UCLA Medical Group member. Can I get a referral to see a specialist at UCLA?
How are UCLA Medical Group HMO/POS referral decisions made?

 

Do I need a referral from my UCLA primary care physician to see a specialist at UCLA?


If you are insured by an HMO, or in some cases a PPO, your health plan will probably require a referral for specialty care. Your primary care physician is your central contact for all medical concerns as this allows for continuity of care for members and allows a central location for medical records. For routine referrals that require pre-authorization, you will be notified of the decision within 7 to 10 working days. If you have not received written or verbal notification from UCLA Medical Group or from your physician within 10 working days, please contact us at (310) 302-1300. Urgent referrals (based upon medical need) are processed within 24 hours. Please wait for the request to be processed before seeking specialty care. Without an authorization, you may become financially responsible for the evaluation, diagnosis, and treatment you receive.


I am enrolled with the UCLA Medical Group as my primary care medical group. Do I need a referral to see a specialist at UCLA?


If you are insured by an HMO, or in some cases a PPO, your health plan will probably require a referral for specialty physician care and some diagnostic tests. Your primary care physician is your key contact for all medical concerns so that all of your services can be coordinated for continuity of care and centralized medical record-keeping. For routine referrals that require pre-authorization, you will be notified of the decision within 7 to 10 working days. If you have not received written or verbal notification from UCLA Medical Group or from your physician within 10 working days, please contact us at (310) 302-1300. Urgent referrals (based upon medical need) are processed within 24 hours. Please wait for the request to be processed before seeking specialty care. Without an authorization, you may become financially responsible for the evaluation, diagnosis, and treatment you receive.


Can I refer myself for women's health services?


Female patients belonging to the UCLA Medical Group may refer themselves to the UCLA Medical Group panel of obstetric/gynecologic (OB/GYN) physicians for annual well-woman visits, obstetrics care, and gynecology services. To serve you better, UCLA Medical Group has broadened its OB/GYN network to include a variety of specialists in Santa Monica and surrounding areas. For a current list of OB/GYNs, you can use the Physician Directory tool on this website or please feel free to contact us at (310) 302-1300.

Below are some helpful links:

Department of Obstetrics and Gynecology

Iris Cantor Women's Health Center

Women's Health Services at UCLA




I am NOT a UCLA Medical Group member. Can I get a referral to see a specialist at UCLA?


If you are insured by a PPO, you may self-refer to specialists at UCLA. Please call the UCLA Physician Referral Service at (800) UCLA-MD1 or (800) 825-2631 for information about our physicians . If you are covered by an HMO, you will need to get an authorization from your primary care physician to be referred to UCLA specialty physicians. Your physician can fax the referral authorization to the UCLA Physician Helpline fax number at (310) 794-8769. If you do not belong to an HMO, please have your physician call the UCLA Physician Helpline at (800) 825-2888 for assistance.


How are UCLA Medical Group HMO/POS referral decisions made?


UCLA Medical Group utilization decision-making for HMO/POS members is based upon approved guidelines and appropriateness criteria from the United States Preventive Services Task Force, Health Plans, UCLA Medical Group, and other sources as well as the applicable Health Plan Evidence of Coverage. The outcome of any specific request may be approval, modification, or denial of a specific service. No individual, including the medical director and the utilization management staff conducting utilization reviews, receives a financial incentive for issuing an approval, modification, or denial of a coverage or service. There are no financial incentives that would encourage under-utilization of medical services. The criteria used in making a referral decision can be requested by a member, a person designated by the member, or by a member of the public by calling us at (310) 302-1300.