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If an OB/GYN finds something during a routine exam that requires additional testing or treatment, can he or she request an authorization without going through the primary care physician?

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If an OB/GYN finds something during a routine exam that requires additional testing or treatment, can he or she request an authorization without going through the primary care physician?

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Yes, if an OB/GYN determines that further medical investigation is needed relating to an obstetric or gynecologic condition, he or she can contact ODS without going through the PCP for an authorization. Nevertheless, the PCP should be informed of the gynecologic condition discovered during the exam. If the medical condition is not related to obstetrics or gynecology, then the PCP will have to initiate any follow-up referrals or authorizations. Some groups have exceptions. Please refer to the OHP Referral & Authorization Guidelines.

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