Published: August 16, 2022
How to use Advantage Referral in 3 steps:
Let’s say you’re at your checkup and your doctor recommends you see a Specialist. So, what now? As a member, you can take advantage of what we call, Advantage Referral.
WHA members are not restricted to their enrolled Medical Group (i.e. where your PCP practices, such as Dignity Health). You can see any Specialist that participates in our Advantage Referral program from among our six Medical Groups (so you are not limited to just one).
Here’s what to expect and the detailed steps to get the Specialist care you need:
- Unlike most HMOs, WHA gives you more choice! When a member requires Specialist care, your PCP can make a referral within their Medical Group to a Specialist. But if a WHA member knows a Specialist they wish to see, just ask your PCP to refer them, assuming he/she is in one of our six Medical Groups.* If a member wants to research first – there are hundreds of Specialists available ranging from allergist and dermatologist to speech therapist and urologist – use our online clinical provider directory (Find a Doctor tool on our website).
- Before you go - ensure referral paperwork is complete! Your doctor will send in a written referral for you, which usually takes about five days (or 72 hours for an expedited request). You’ll get a confirmation letter, so when you call to make an appointment with a Specialist, confirm they’ve received the referral from your doctor. If you receive care from a WHA network Specialist prior to receiving a referral, you may be liable for the cost of their services. Most importantly, be an advocate for your own care and call your PCP if you haven’t received the referral. When you get the referral, it may state a specific number of visits, or a specific service you were referred for, so it’s important to review the referral for any specifics as well as when the referral expires.
- Continuing with a Specialist means that you may not have to get a referral each visit. Getting services such eye exams, or OB/GYN services for women, don’t require a PCP referral as long as the Specialist participates in Advantage Referral, but some procedures may require prior authorization. There are also some facilities (hospitals, nursing home) and services (such as imaging, planned hospitalizations or surgeries) where a WHA member must stay within their doctor’s medical group.
If you have seen a Specialist for a specific reason, say a surgical procedure, and a year or more later you have a new symptom, or a flare up, and has not been seeing that Specialist regularly for care, you will need to alert your PCP to be referred again.
Finally, anytime a WHA member wants to go to a WHA care partner, such as chiropractic care from Landmark Healthplan of CA, ensure you choose a provider from that partner network.
As always, our WHA Member Services team is available at 916.563.2250 or 888.563.2250 toll-free to help you find a doctor and answer any questions you may have. See more on the Advantage Referral webpage.
*WHA’s Network includes over 3,200 doctors and specialists from the following Medical Groups: Dignity Health's Mercy Medical Group, Woodland Clinic, Hill Physicians in Sacramento and Solano, Meritage Medical Network, NorthBay Health; and Providence.