How It Works For You!
Members can choose a Specialty Provider from our Self Referral Specialty Network
Provider listing for the services listed below. You choose when you want to see
the specialist. It’s that simple!
- Annual Well Woman Visits
- Health Education
- Routine Hearing Tests for Medicare Advantage Plan (MAP*) (Senior HMO) members
- Annual Mammogram for women 40 years old or over ??Patient Education (Bright Beginnings
(Prenatal), Living With Asthma, Living With Congestive Heart Failure, Nutrition,
Diabetic Education, Weight/Cholesterol Management)
- Nail Care for MAP* (Senior HMO) members (Note: Members with the following medical
conditions must consult their Primary Care Provider: Diabetes, Peripheral Vascular
Disease, Skin Ulcers or Open Sores, Fungal Infections, Cold Feet (Raynaud Syndrome)
- Dermatology Consultation MAP* (Senior HMO) members can now self refer once every
- Mental Health for our Seniors (except Healthnet Senior Medicare Programs) may self
refer to Windstone Behavioral Health
We've made referrals to our Direct Referral Network Specialists fast and simple
for you and your Primary Care Provider! If your Primary Care Provider feels that
a referral to a Specialist is needed, he/she can refer you directly for care with
no additional authorization needed. The specialties listed below are available to
you through your Primary Care Provider and Direct Referral.
- Annual Mammogram for women 39 years old or younger
- Health Education for 1:1 Counseling
- Geriatric Assessment (Seniors Only Evaluation Clinic)
- Pulse Oximetry
- Pharm. D. Consultative Services
- Routine Lab
- Routine X-ray
- Social Service Consultative Services
Prior Authorization Referrals
(All other Specialties not listed above) A referral that is initiated by your Primary
Care Provider or Specialist and is faxed to Desert Oasis Healthcare's Utilization
Management Department for prospective review by the Utilization Review Committee.
Services available through Self, Direct & Prior Authorization Referrals must be
rendered by an APPROVED NETWORK SPECIALIST.
NOTE: Authorized provider for some specialties is based on Primary Care Physician assignment.
*Medicare Advantage Plans (MAPs) (Senior HMO):
- Affirmative Statement About Incentives
- Utilization Management (UM) decision making is based only on appropriateness of
care and service and existence of coverage.
- The organization does not specifically reward practitioners or other individuals
for issuing denials of coverage or service care.
- Financial incentives for UM decision makers do not encourage decisions that result
Aetna Medicare, Anthem Blue Cross, Blue Shield, Care1st Health Plan, Easy Choice Health Plan, Health Net, Inter Valley Health Plan, SCAN Health Plan and UnitedHealthcare.
Call for a list of approved Referral Network Specialists.
Referral Department: 1-760-320-5134, 1-800-500-5215, 1-760-320-5764 TTY for the hearing