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Updated policy for Direct Access to OB/GYN services 

October 2, 2019    

AmeriHealth allows commercial members to obtain obstetrical/gynecological (OB/GYN) services without a referral from their primary care physicians (PCP). PCPs certified in family planning, as well as OB/GYN providers, can provide direct access to these services.

We have updated our medical policy language, effective October 7, 2019, to reflect this change by removing:

  • examples of services not requiring referrals from PCPs or OB/GYN providers;
  • examples of OB/GYN services that require precertification in accordance with HMO product rules;
  • examples of OB/GYN services that require referrals from PCPs and OB/GYN providers.

Information about these services can also be found in the Provider Manual for Participating Professional Providers, which is available through the NaviNet® web portal (NaviNet Open).

Learn more

For more information about Direct Access OB/GYN services, please refer to Medical Policy #00.09.01f: Direct Access to Obstetrics/Gynecology Services.

To view this policy, visit our Medical Policy Portal

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