Your doctor might want you/your child to see a special doctor (specialist) for certain health care needs. While you/your child’s doctor can take care of most of your health care needs, sometimes they will want you/your child to see a specialist for your care. A specialist has received training and has more experience taking care of certain diseases, illnesses and injuries. Superior has many specialists who will work with you and your doctor to care for your needs.
The doctor will talk to you about your/your child’s needs and will help make plans for you to see the specialist that can provide the best care for you. This is called a referral. Your/your child’s doctor is the only one that can give you a referral to see a specialist. If you/your child has a visit, receives services from a specialist without your doctor’s referral, or if the specialist is not a Superior provider, you might be responsible for the bill. In some cases, an OB/GYN can also give you a referral for related services.
Some specialist referrals from your/your child’s doctor may need approval from Superior to make sure the specialist is a Superior specialist, and the visit to the specialist or the specialty procedure is needed. In these cases, the doctor must first call Superior. If you or your doctor are not sure what specialty services need approval, Superior can give you that information. Superior will review the request for specialty services and respond with a decision. This will not take more than two (2) business days after getting all the needed information from your doctor. Decisions are made more quickly for urgent care.
You do not need a referral for:
- True emergency services
- OB/GYN care
- Behavioral health services
- Routine vision services
- Dental services
- Family planning services
Child and Adolescent Needs and Strengths (CANS) Assessment
Within 30 days of removal and annually thereafter, children (3 or older) must get a CANS assessment. The CANS assessment is a comprehensive trauma-informed behavioral health evaluation. It gathers information about the strengths and needs of the child and helps in planning services that will help the child and family reach their goals. The CANS assessment must be performed by a certified CANS provider. To see a list of doctors in your area who can do a CANS assessment, go to Find A Doctor. You can also call Member Services at 1-866-912-6283 to get help finding a doctor.