Referrals and Authorizations
If your doctor cannot treat you, your doctor will refer you to another doctor. Your doctor can also refer you to have a test or other services. This is called a referral. Your doctor will complete a referral form that you can bring to the other doctor, lab, hospital, or other health care provider.
Some health care services need to be approved before you get them. This is called pre-authorization. All services given by non-participating doctors must be pre-authorized.
If your doctor thinks you need a service he/she will send a referral form to FHN. Your doctor will share the information needed to make a decision on the service.
FHN’s Utilization Management staff will check the referral and the information given by your doctor. Our decision is based only on the right care and services for you. FHN will also check if the service asked for is a covered benefit or not.
A doctor reviews all denials and makes a final decision. If you do not agree with the decision, you can file an appeal. Your FHN member handbook says how to file an appeal.
If you have questions about what services are covered, call Member Services. The phone number to call is 1-888-346-4968.