Referrals and preapprovals in Iowa

For some Iowa Medicaid services, you’ll need a referral from your primary care provider (PCP) before getting care.

When to get a referral

You’ll need to get a referral from your PCP before:

Meeting with a specialist.

Going to a hospital for nonemergency care.

Getting certain medicines, tests, and services.

For most services, you'll go to your PCP or another provider in our plan. But there are some services we'll pay for, even if you get them from a provider who's not in our plan. These are called self-referral services.

You don’t need a referral from your PCP for:

Emergency care
Family planning services
Yearly OB/GYN exams and prenatal care
Behavioral health and substance use disorder services
Sexually transmitted disease (STD) testing

Have questions?

Check your member handbook or live chat with a representative through the online portal or the Sydney Health app.

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Referrals and preapprovals in Iowa

When to get a referral

Self-referral services

You may need preapproval for a service

Your PCP will need to send in a preapproval for:

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