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Except for emergency services, post-stabilization services, and services provided to you during an approved inpatient admission, all services from an out-of-network provider must be prior authorized. Claims for services from out-of-network providers that are not approved before the service is given may be denied.

Call 1-877-782-6440 (TTY 711 or 1-800-735-2989), Monday through Friday 8 a.m. to 6 p.m. Central time.

You cannot go to a specialist without your PCP's referral. We will only pay for a specialist visit if your PCP sends you.

Do members need a referral to see a specialist? A PCP is required to refer a member to a specialist when medically-necessary care is needed beyond the scope of the PCP. A specialist cannot refer to another specialist. All member care should be coordinated through the PCP.

Amerigroup STAR+PLUS MMP integrates care and reimbursement for Texas members who have Medicare Part A, Medicare Part B, Medicare Part D and Medicaid benefits (dual-eligible members) and consolidates their care through one Medicare-Medicaid Plan for full access to both their Medicaid and Medicare benefits.