We have a large network of doctors, hospitals, and specialists who are committed to providing you with good medical care. Our health plan was founded on the belief that you and your primary care provider (main doctor) are the 2 best qualified to care for your health. Think of your main doctor as your medical home. If you are sick, need a checkup, or if you have a medical question, call your main doctor.
Your primary care provider will give you all your routine medical care and will refer you to a specialist or hospital when needed. A referral is when your primary care provider arranges for you to go to another doctor. He or she will tell you exactly what kind of specialist or tests you need for your illness or condition.
Most of the time, you will need to go to your primary care provider first. If you choose to go to another doctor, you might have to pay for the services. Remember—always take your Texas Children’s Health Plan ID card and Your Texas Benefits Medicaid Card with you each time you get health care.
Other services that do not require a referral from your primary care provider
There are other certain types of health care that you can get without being referred by your primary care provider.
Those services include (when given by a Texas Children’s Health Plan network provider):
- Emergency care
- OB/GYN care
- Prenatal care
- Behavioral health services or drug and alcohol treatment
- Texas Health Steps medical and dental checkups
- Family planning services
- Vision care
- Mental health or substance use services
For Dual-Eligible Members
If you are a dual-eligible member, you have Medicare coverage and should receive your primary, acute, and some behavioral health services from your Medicare provider. Texas Children's Health Plan will provide your long-term care services, Medicaid covered behavioral health services not covered by Medicare, and coordinate with your Medicare providers. If you have any questions, please talk with your Service Coordinator, or you may call 1-800-659-5764 to speak to one of our Member Services advocates.
To pick a main doctor, you can use our online “Find a Doctor” tool here, or you may click on one of the following links to open our provider directory. If you need help or have questions, please call Member Services.
Find a Doctor
If you can’t find your doctor or if you need help, call Member Services toll-free at 1-800-659-5764 (STAR Kids)