On the Sana First Health Plan (SFHP), Sana Care is your starting point for most care. If you need in-person or specialty care, Sana Care and Care Navigation will help guide you to the right provider and coordinate your referral.
A referral lets Sana and your provider know that you've completed the required guided-care process before receiving outside care.
When Is a Referral Required?
For members on SFHP, a referral from Sana Care is required for almost all non-emergency medical care received outside of Sana Care, including:
- Specialist Visits: Dermatologists, cardiologists, orthopedists, gastroenterologists, etc.
- Therapy Services: Physical, occupational, and speech therapy
- Outpatient Care: Outpatient procedures, surgeries, and specialized treatment centers
- Mental Health: Mental health care, including therapy, counseling, and psychiatry
- Pediatric Specialist Care: Any specialist recommended by your child's primary care pediatrician
How to Get a Referral
For Adults
- Connect: Open the Sana App or log in to your portal and start a message with Sana Care.
- Evaluation: Your Sana Care provider will evaluate your symptoms and determine if in person or specialist care is necessary.
For Children
Sana Care does not provide direct pediatric primary care. Your child will continue seeing their regular pediatrician for routine checkups. If their pediatrician recommends a specialist:
- Log In & Switch Profiles: Open the Sana App and toggle to your child’s sub-profile.
- Upload Documentation: Connect with Care Navigation and upload a copy of your pediatrician’s referral letter or After Visit Summary recommending the specialist.
Step-by-Step: What Happens After You Need Care?
Once medical necessity is established, Care Navigation guides you through the process:
- Care Navigation Shortlist: Care Navigation reviews your medical needs, location, provider quality, and pricing to send you a curated list of provider options.
- Select Your Choice: Review the options and let Care Navigation know which provider you prefer.
- Receive Referral Packet: Sana generates a referral packet containing your unique authorization packet and faxes it directly to your chosen provider's office.
- Schedule & Confirm: Contact the provider’s office directly to schedule your appointment.
Always Exempt Care (No Referral Needed)
Certain care categories never require a referral. You can access the following directly:
- Emergency Room (ER) Visits (If you are experiencing a medical emergency, call 911 or go directly to the nearest emergency room. Never delay seeking emergency care for a referral.)
- Urgent Care Center Visits
- Mental Health Care
- OB/GYN Care
- Pediatric Primary & Preventive Care (routine well-child checkups with their primary pediatrician or family medicine doctor)
What Happens If I Don't Get a Referral?
For care that requires a referral, you must complete the Sana Care referral process before receiving care.
If you receive care that requires a referral without completing this process first, the claim will be denied and you'll be responsible for 100% of the cost.
Follow-Up Care & Diagnostic Tests
- Routine Follow-Ups: If your treating specialist recommends follow-up visits within the approved scope of your initial referral, you generally do not need a new referral.
- New Specialist or Surgery: If your specialist recommends that you see a different specialist or consult with an outside surgeon, Sana Care and Care Navigation must review and issue an updated referral packet before you book.
- Labs & Standard X-Rays: Routine labs, bloodwork, or standard X-rays ordered directly by your treating specialist during an authorized visit typically do not require a brand new referral.
Referral Packet vs. Prior Authorization: What's the Difference?
It is important to understand that a Referral Packet and a Prior Authorization are two separate requirements:
- Referral Packet: The pre-approval step on SFHP allowing you to consult with an outside specialist or facility for a condition.
- Prior Authorization (PA): A clinical safety and medical necessity review required for specific high-cost or complex services (such as MRIs, CT scans, outpatient surgeries, sleep studies, genetic testing, or pain injections) regardless of plan type.
Important Note: Having an approved Sana Care referral on file authorizes your consultation with a specialist, but it does not replace a Prior Authorization requirement for complex procedures. Your specialist’s office must submit a separate Prior Authorization request to Sana before performing high-cost procedures.
Have questions? We've got you covered.
- Log in to view account details.
- Search FAQs in our Help Center.
- Connect with Customer Support directly through the chat icon on most Sana pages or call us at (833) 726-2123 Monday through Friday, 7 AM to 7 PM Central.