Out-of-Network Referrals

Can I see a specialist who is not in your PersonalCare Plan Partner System?

If your Virginia Mason, Edmonds Family Medicine or The Polyclinic primary care provider (PCP) determines you need to receive care that they are unable to provide, your PCP will:

  1. Look for a specialist within Virginia Mason or The Polyclinic.
  2. If the needed specialist is not available within Virginia Mason or The PolyClinic, your PCP will look within the Virginia Mason PersonalCare Partner network.
  3. If your PCP is unable to locate a specialist within the PersonalCare Partner network, your PCP will look within the Premera Blue Cross Heritage Signature provider network.

If a specialist is located within the Premera Blue Cross Heritage Signature network, your PCP will submit a referral request to Premera Blue Cross. Premera will review the request through its prior authorization process and:

If approved, the referred specialist's services will be covered as in-network.

If denied, but you proceed with receiving care, you'll pay significantly higher out-of-pocket expenses because the care won't be covered.

Are self-referrals possible?

You can only self-refer within your Virginia Mason Partner System. If you self-refer to a provider outside of your Partner System, including those in the Premera Blue Cross Heritage Signature network, you'll pay significantly higher out-of-pocket expenses because the service won’t be covered.

Understanding your network can save you money – PLEASE ASK BEFORE YOU GO.

If you're unsure or want to verify which providers or specialists are included in your Partner System, please call the phone number on your Premera ID card. A Premera customer service representative will be happy to help.

Save this important out-of-network referral notice.