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Getting care from specialists

If you have a special health problem, your PCP may send you to a specialist. A specialist is a doctor trained to treat certain health problems. Specialists can include:

  • Heart doctors (cardiologists)
  • Skin doctors (dermatologists)
  • Doctors for women’s issues (gynecologists)
  • Doctors for pregnant women (obstetricians)
  • Doctors for blood problems (hematologists)
  • Foot doctors (podiatrists)
  • Eye doctors (ophthalmologists)
  • Cancer doctors (oncologists)
  • Surgeons

In most cases, you will need to get a referral from your PCP to see a specialist. Please see the referrals section for more information. Your PCP can help you choose a specialist and make an appointment. You can get a list of Keystone First specialists clicking on Find a Provider, or by calling Member Services.

If you would like to have more information about our Keystone First providers, call Member Services. You can find out information like where they went to medical school, where they did their residency and if they are board certified.

Specialist office visits

Keystone First covers your visits to specialists in our network. There is no limit to how many times you may see the specialist. Remember to get a referral if one is needed from your PCP before you visit a specialist. There may be co-pays for your visits to some specialists. Please see the member co-payment schedule (PDF). If the specialist thinks you need surgery or other special treatment, you can ask to see another specialist. This is called a “second opinion.” If you want a second opinion, ask your PCP for a referral to another specialist in a different practice within the Keystone First network.

Out-of-network specialists

Visits to specialists who are not in the Keystone First network will need to have prior authorization (prior approval) from Keystone First. Your PCP has a special number to call to get prior authorization. Ask your PCP to help you.

If Keystone First does not have at least 2 specialists to choose from who can treat your health problem, you have the right to ask to see a specialist who is not in the Keystone First network. Talk to your PCP about this.

If you also have Medicare coverage, you have the right to seek Medicare-covered services from the Medicare provider of your choice. If you have questions about out-of-network specialists, please call Member Services.