On the Sana First health plan, most non-emergency specialist and outside medical care requires an active referral from Sana Care to be covered. However, several key care categories are exempt from referral requirements.
Understanding these exceptions helps you access urgent care quickly without delays.
Referral Exceptions (No Referral Required)
1. Emergency Room (ER) Care
- Referral Required? No.
- How It Works: If you are experiencing a life-threatening medical emergency, call 911 or go directly to the nearest emergency room immediately. Never delay emergency care to seek a referral or contact Sana Care.
- Coverage: Emergency room services are always covered under your standard plan emergency benefits without needing a referral packet or authorization.
2. Emergency Transportation
- Referral required? No.
- How It Works: Emergency transportation does not require a Sana Care referral. If you need emergency transportation, such as ambulance services, do not delay getting the care you need.
3. Urgent Care Centers
- Referral Required? No.
- How It Works: For urgent, non-life-threatening medical issues that arise after hours or when virtual care isn't suitable (such as minor cuts requiring stitches, sprains, or sudden illness), you can visit any urgent care center directly.
- Coverage: Urgent care visits are always covered under your standard plan benefits without needing a referral packet or authorization.
4. OB/GYN
- Referral Required? No.
- How It Works: While you have the freedom to schedule directly with an OB/GYN or reproductive specialist of your choice, we encourage connecting with Sana Care first. Our Care Navigation team can take the work off your plate by recommending top-rated providers in your area, confirming network participation, and helping you book appointments for prenatal care, annual well-woman visits, family planning, or specialist conditions.
- Coverage: All routine and specialist OB/GYN and reproductive healthcare services are fully covered under your standard plan benefits without needing a referral packet or prior authorization.
5. Mental Health Services
- Referral Required? No
- How It Works: You have direct access to licensed mental health professionals—including therapists, counselors, and psychiatrists. While a referral is never required, Sana Care is available to match you with providers who fit your clinical needs, scheduling availability, and preferred visit format (in-person or telehealth). If you already have a preferred provider, you can book with them directly.
- Coverage: In-person and virtual visits billed by licensed mental health providers are covered under your standard behavioral health plan benefits without prior authorization.
- Important Note: Monthly subscription-based mental health apps or recurring membership fees are not covered under any Sana plan. Care must be billed as standard medical visits from a licensed provider under your plan’s mental health benefits.
6. Pediatric Primary & Preventive Care
- Referral Required? No.
- How It Works: Children on a Sana First health plan continue seeing their community primary care pediatrician or family medicine doctor for well-child checkups, routine vaccinations, sports physicals, and everyday acute illness visits. While Sana Care does not provide direct pediatric primary care visits, our Sana Care team can help you identify high-quality, in-network pediatricians or family practices in your local area, verify their accepted insurance, and assist in getting established.
- Coverage: Routine pediatric primary and preventive care visits with your child’s doctor are always covered under your standard plan benefits without needing a referral packet or authorization.
Care Requiring a Referral
Pediatric Specialist Care
- Referral Required? Yes.
- How It Works: While routine primary care visits with your pediatrician are exempt, seeing a pediatric specialist (such as a pediatric cardiologist, allergist, or dermatologist) does require a Sana referral packet to ensure claim coverage.
How to Get Authorized:
- Have your child's primary care pediatrician evaluate your child and provide a written referral or recommendation.
- Open the Sana App or log in to your member portal, toggle to your child's sub-profile, and message Care Navigation directly.
- Upload a copy of your pediatrician's referral or After Visit Summary. Care Navigation will issue the official referral packet for the specialist.
Not Sure If You Need a Referral?
If you're unsure whether your care requires a referral, contact Sana Care or Care Navigation before scheduling or receiving care. We'll help you understand the right next step.
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.