Primary care & referrals
Can I select a primary care provider before my first visit?
Yes. You do not need to visit a primary care provider before selecting them as your primary provider. Use Find Care (opens in new tab) to compare in-network options by location, language, and other preferences.
If your plan requires a selection, record your choice in your Oscar account (opens in new tab). You can change it later.
Do I need a referral to see a specialist?
It depends on your plan. If you have a Texas Guided Care HMO plan, you need a referral from your primary care provider for most specialist visits. Be sure to check your selected or assigned primary care provider.
Some types of care don’t require a referral, including eligible OB-GYN care, emergency care, urgent care, and behavioral health services. See Oscar’s Referral Resources (opens in new tab) for more details.
Not sure if you need a referral? Check your plan documents in your Oscar account (opens in new tab) call your Care Team at (855) 672-2755 before scheduling a specialist visit.
Do I need to choose a primary care provider, and can I see a different one?
Check your plan documents to see whether you need to select a primary care provider. Texas Guided Care HMO members need a selected or assigned primary care provider for most specialist referrals.
You can see another in-network primary care provider. For Texas Guided Care HMO, referrals must still come from your selected or assigned primary provider, or an eligible primary provider in the same practice.
Use Find Care (opens in new tab) to find an in-network primary care provider. Log in to your Oscar account (opens in new tab) to review or change your selection, or call your Care Team at (855) 672-2755. If your plan does not require a selection, you can visit an in-network primary care provider without recording a choice.
How can I find a primary care provider?
Use Find Care (opens in new tab) to search for a primary care provider in your plan’s network. Choose your plan and location, then narrow your search by language and other preferences.
If you have Texas Guided Care HMO, record your selected primary care provider in your Oscar account (opens in new tab). If you need help finding an available provider, call your Care Team at (855) 672-2755.
How do I change my selected primary care provider?
If your plan requires you to select a primary care provider, sign in to your Oscar account (opens in new tab) or the Oscar app to review or change your selection. Texas Guided Care HMO members can use these tools or contact their Care Team for help.
For Texas Guided Care HMO plans, confirm that the new provider is listed in your account before getting a referral from them. If your plan does not require a selection, you can visit an in-network primary care provider without recording a choice.
How do I get a referral if my primary care provider has no appointments?
If you have a Texas Guided Care HMO plan, call your selected primary care provider’s office and ask whether another eligible primary care provider in the same practice can see you and submit the referral.
If the office cannot help, call your Care Team at (855) 672-2755 for next steps.
How do I get or correct a specialist referral?
If your plan requires a referral, contact your primary care office before your specialist visit.
For Texas Guided Care HMO plans, your referral must come from your selected primary care provider’s office. If you haven’t chosen a primary care provider, Oscar will assign one to you.
You can check your referral details, including the specialty and valid dates, in your Oscar account (opens in new tab). If something looks wrong, contact the provider’s office to have it corrected.
Not sure which primary care provider is listed on your plan? Check your Oscar account or contact your Care Team.
What does it mean to select a primary care provider?
Selecting a primary care provider means recording the provider you choose in your Oscar account (opens in new tab). Your plan documents explain whether a selection is required and whether that provider must submit specialist referrals.
Texas Guided Care HMO requires a selected or assigned primary care provider for most specialist referrals. If your plan does not require a selection, you can visit an in-network primary care provider without recording a choice.
When should I select a primary care provider?
If your plan requires a primary care provider, choose one before your coverage starts. Texas Guided Care HMO members who do not choose a provider will have one assigned and can change it later.
Log in your Oscar account (opens in new tab) to see your selected or assigned provider. Plans that do not require primary care provider selection do not have a selection deadline.
Where can I see my selected primary care provider?
If your plan requires a primary care provider, sign in to your Oscar account (opens in new tab) or the Oscar app to see your selection. For Texas Guided Care HMO, this primary care provider coordinates most specialist referrals.
Plans that do not require a selection may not display in your account.
Why does my referral say “pending PCP change”?
This status means the referral was submitted by a primary care provider who is not recorded as your selected primary care provider or an eligible primary care provider in the same practice.
Check the primary care provider listed in your Oscar account (opens in new tab). You can update your selection to the provider who submitted the referral or ask your currently selected provider to submit a new one. Confirm that the referral is active before your specialist visit.
Why is it helpful to have a primary care provider?
A primary provider gives you routine care, gets to know your health history, and helps you manage health concerns. They can also recommend a specialist when you need one.
Some plans require you to select a primary provider or get referrals for specialist care. Check your plan’s requirements before scheduling a visit.
You can always log in to your Oscar account (opens in new tab) to review your plan documents.