Out-of-Network Referrals

Need to see a specialist who is not in your PersonalCare Plan Partner System?

If your Virginia Mason 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 for review:

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

If denied, but you proceed with receiving care, you may have to pay the full cost out of your own pocket — with the exception of medical emergencies.

Are self-referrals possible?

You may only self-refer within your Virginia Mason Partner System. If you self-refer to a provider outside of the Virginia Mason Partner System, including those in the Premera Blue Cross Heritage Signature network, you may have to pay the full cost out of your own pocket—with the exception of medical emergencies.

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.