Menu

Getting Care From Specialists

If you child needs specialized care that their PCP cannot offer, your child can see any in-network specialist you choose without a referral. A specialist is a doctor who is trained and practices in a specific area of medicine. Specialists can include:

  • Heart doctors (cardiologists)
  • Skin doctors (dermatologists)
  • Doctors for women’s issues (gynecologists)
  • Doctors for pregnant women (obstetricians)
  • Doctors for blood problems (hematologists)
  • Foot doctors (podiatrists)
  • Eye doctors (ophthalmologists)
  • Cancer doctors (oncologists)
  • Surgeons

Keystone First – CHIP covers your visits to specialists in our network. There is no limit to how many times you may see the specialist.

If your child sees an in-network specialist, it will be covered. Certain copays may apply. Please see the Enrollee Benefits at a Glance (PDF) for more information on copayments.

There are some treatments and services that your child’s specialist must ask Keystone First – CHIP to approve before your child can get them. Your child’s specialist will tell you what those services are. If you have trouble getting your child the specialist care you think they need, contact Keystone First – CHIP’s Enrollee Services at 1-844-472-2447 (TTY 711).

If the specialist thinks your child needs surgery or other special treatment, you can ask for your child to see another specialist. This is called a “second opinion.” If you want a second opinion, ask your child’s PCP for a referral to another specialist in a different practice within the Keystone First – CHIP network.

If you would like to have more information about our Keystone First – CHIP providers, call Enrollee Services or visit the Provider Directory. You can find out information like where they went to medical school, where they did their residency and if they are board certified.

Out-of-network specialists

Visits to specialists who are not in the Keystone First – CHIP network will need to have prior authorization (prior approval) from Keystone First – CHIP. Your child’s PCP has a special number to call to get prior authorization. Ask your child’s PCP to help you.

If Keystone First – CHIP does not have at least 2 specialists to choose from who can treat your child’s health problem, you have the right to ask for your child to see a specialist who is not in the Keystone First – CHIP network. Talk to your child’s PCP about this.