Maine law requires health plans to honor referrals from out-of-network Direct Health Care (DHC) providers. (DHC providers do not submit claims to Harvard Pilgrim for their services. Members pay a flat annual fee to these providers, and can see them as often as needed, for primary care.). DHC providers can refer patients to specialists. DHC providers can also submit prescriptions for specialty pharmaceuticals. Maine law defines a Direct Health Care provider as an individual who is a licensed allopathic physician or osteopathic physician or other advanced health care practitioner who is authorized to engage in independent medical practice in the state of Maine and who chooses to practice direct health care by entering into a direct health care service agreement with patients.

If your provider needs information on how to submit a referral, read the full notice.