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Referrals

The Health Tradition and Health Tradition CarePlus plans are different and have separate requirements for certain services.

If you are unsure which plan you have, verify by looking at your member ID card. Then, review the referral process for your health plan:

  • To avoid incurring costs for services that are denied because you do not have an approved referral prior to service
  • To obtain the best care and health outcomes

Please Note: In addition to obtaining referrals, a prior authorization from your Health Tradition Health Plan may be required for some services, including any inpatient admission. You can find the list of services requiring prior authorization on our Prior Authorization page. 

 

Referral Information for
Health Tradition 
 

  • Health Tradition Employer Groups

Referral Information for
Health Tradition CarePlus 
 

  • Health Tradition CarePlus Employer Groups 

Health Tradition Member Referral Information

  • Health Tradition does not accept referral requests submitted after services have been provided. The referring provider must submit a referral request in writing to Health Tradition for approval prior to the member seeing the provider, or you will be responsible for the entire cost of the services.
  • Referrals are not required for visits with In-Network Providers.
  • Health Tradition does not cover services provided by Out-of-Network Providers. However, a referral to see an Out-of-Network Provider may be considered in very limited circumstances but will not be considered if there are In-Network Providers who can deliver the same care.
  • If you are approved to see an Out-of-Network Provider, services will be reimbursed at the in-network cost-sharing amount, subject to our maximum allowable fee. You can be balance billed by Out-of-Network Providers for any difference between their billed amount and our maximum allowable fee.
  • A decision notification letter is sent to the member, the referring provider, and the referred-to provider. Additionally, both the referring provider and the referred-to provider will receive a copy of the decision notification letter via fax.   
  • You can access your Maddy Portal account to check on the status of your referral request or call the Customer Service Team and one of our customer service representatives will assist you.
  • Go to the Prior Authorizations page or check with your Health Tradition Customer Service team to determine if a prior authorization is required for the services you are seeking to have done.

Health Tradition CarePlus Referral Information

  • Health Tradition does not accept referral requests submitted after services have been provided.
  • Referrals are required for visits with In-Network Specialists.
  • Please Note: Audiology, Behavioral Health, Chiropractic, Dental, Dieticians, Home Nursing Care, OB/GYN, Ophthalmology, Optometry, Oral Surgery and Rehabilitation Medicine (PT, OT, ST) services with In-Network Providers do NOT require a referral.
  • Any In-Network Provider can submit a referral request for a member to see an In-Network Specialist, which must be reviewed and approved by Health Tradition before the services are incurred, or you will be responsible for the full cost of the services.
  • Health Tradition CarePlus does not cover services provided by Out-of-Network Providers. However, a referral to see an Out-of-Network Provider may be considered in very limited circumstances but will not be considered if there are In-Network Providers who can deliver the same care.
  • If you are approved to see an Out-of-Network Provider, services will be reimbursed at the in-network cost-sharing amount, subject to our maximum allowable fee. You can be balance billed by Out-of-Network Providers for any difference between their billed amount and our maximum allowable fee.
  • In both instances, a decision notification letter is sent to the member, the referring provider, and the referred to provider. Additionally, both the referring provider and the referred to provider will receive a copy of the decision notification letter via fax.  
  • You can access your Maddy Portal to check on the status of your referral request or call the Customer Service Team and one of our customer service representatives will be happy to assist you.
  • It is important to go to the Prior Authorization page or check with your Health Tradition Customer Service team to determine if a prior authorization is required for the services you seek.