There may be times when your PCP thinks your child needs to be seen by a "specialist." A specialist is a doctor who only deals with certain illnesses or injuries. The PCP will set up for your child to be seen by the specialist. This is called a "referral."

The PCP will work with the Seton Health Plan case managers. Together, they will make sure your child is seen by the right kind of specialist within our network. If the Seton Health Plan network does not have the kind of specialist you need, our case managers will find one for you.

You cannot go to a specialist unless you have a referral from your PCP. The only services that do not need a referral from your PCP are:

• OB/GYN Services, such as care related to pregnancy and all gynecological conditions. (Family planning and medications prescribed only for contraception are not covered)
• Behavioral Health Services

The appointment with the specialist depends on many things. Either your child's medical condition, the type of specialist, or the location of the specialist may determine when you will be seen. You should be able see the specialist within 2 weeks.