Seeing a Specialist
You should speak about your health care needs with your primary care provider (PCP). But, you do not need to get a PCP referral to see a specialist in the AmeriHealth Caritas Delaware network.
What is a specialist?
Your PCP can treat most health problems. However, there may be times when you need to see a specialist. A specialist is a doctor trained to treat certain health problems.
Specialists can include:
- Heart doctors (cardiologists).
- Skin doctors (dermatologists).
- Doctors for women’s health (gynecologists).
- Doctors for pregnant women (obstetricians).
- Doctors for blood problems (hematologists).
- Foot doctors (podiatrists).
- Eye doctors (ophthalmologists).
- Cancer doctors (oncologists).
- Behavioral health doctors (psychiatrists).
How to get care from a specialist
You can find specialists in our network by using Find a provider. You do not need a referral to see a specialist in our network. A specialist may think you need surgery or other treatment. You can ask to see another specialist. This is called a “second opinion.”
If you want a second opinion, ask your PCP to help you find another specialist in our network. If there is not a network participating provider available, a second opinion from a health provider outside of the network can be obtained, at no cost to you. Prior authorization is required for out-of-network referrals. There is no limit to how many times you may see the specialist.
You need prior approval to see providers who are not in our network. Your doctor will help you get approval.
Sometimes, we may not have a provider who can treat your health problem. You can ask to see a provider who is not in our network. Talk to your PCP about out-of-network providers.
If you are dually eligible for Medicaid and Medicare and receive an order from an out-of-network Medicare provider for services we cover, but Medicare doesn’t, you must use a provider who is in the network.
If you have questions about out-of-network providers, call AmeriHealth Caritas Delaware Member Services, 24 hours a day, seven days a week, at:
- Diamond State Health Plan: 1-844-211-0966 (TTY 1-855-349-6281).
- Diamond State Health Plan-Plus: 1-855-777-6617 (TTY 1-855-362-5769).