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Q & A for SHIP Members

Q. When do I need a referral to see a health care provider?

A. This is an important question to ask every time you need care from a provider outside of Gannett. Asking it will help you maximize your coverage under the SHIP. The SHIP Member's Guide provides detailed information about referrals, in-network providers, and out-of-network providers.

To receive care from a health care provider in the Ithaca area

  • When you are in the Ithaca area and need health care, you must use the resources of Gannett Health Services first. Gannett is your primary care provider.
  • If your care cannot be provided at Gannett, your primary care provider at Gannett may refer you to a specialist in the community. Whenever you need care from a non-Gannett provider in the Ithaca area, you must obtain a written referral from a Gannett clinician. To receive the maximum benefit for services covered by the SHIP in the Ithaca area, you must have a referral to an in-network provider.
  • If you have just enrolled in the SHIP and are receiving care for a medical condition, you must make an appointment at Gannett to establish a relationship with a primary care physician. If necessary, s/he will provide a referral to an in-network provider for specialty care.
  • If you have been continuously enrolled in the SHIP and are receiving care from an in-network provider, a new referral is required each plan year for ongoing treatment to be covered. Talk with your primary care provider before the new plan year begins (August 17) to discuss a new referral.

No referral is necessary for

  • An emergency medical condition (see definition in Member's Guide); however, follow-up care must be provided at Gannett or by Gannett referral to a specialist
  • Maternity care
  • Two annual GYN exams and one routine Pap smear for women age 18 and older
  • Care received when outside the Ithaca area. We encourage you to discuss your needs with the health care provider on call at 607 255-5155.

Note: Gannett is closed for the following holidays: Thanksgiving Weekend (Thursday through Sunday), for the week of December 25 to January 1 (and adjacent weekend days), Memorial Day in May, and Independence Day (in July).

To receive care from a health care provider when you are away from Ithaca

When you are away from Ithaca, you do not need a referral to seek Preferred Care from Aetna's Open Choice PPO network or to seek Non-Preferred Care.

You can locate a provider using Aetna’s DocFind Service at www.aetna.com/docfind. Be sure to include the zip code of the area where services will be received and to select Aetna Standard Open Choice PPO as the health plan type.

Last Updated: 6/18/2007