Do I need to get a referral from my Primary Doctor for a Mammogram if I'm over 40?
According to your specific benefit plan, Mammograms do not require a referral.
When performed for preventive or routine purposes, benefits are payable 100% when received in network. If for some reason there is a medical concern in nature warranting the service to be rendered, then eligible services are payable at an 80% coinsurance level following your $5500 deductible being met. There is a $6550 plan maximum out of pocket.
You can locate additional information here:
How do I find out my benefit information?
What providers are in my network?
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