Do you need a referral for therapy under The Empire Plan?

The short version: usually no referral needed

One of the most common worries we hear is, "Don't I need my doctor to refer me first?" For most NYSHIP members on The Empire Plan, outpatient therapy doesn't require a referral. You can contact an in-network therapist and begin care directly — no waiting on a primary-care appointment or paperwork from another office.

Why people assume they need one

Referrals are common for seeing medical specialists under some insurance plans, so it's natural to assume mental health works the same way. But behavioral health benefits often work differently — and under The Empire Plan, members can typically access outpatient therapy without a referral step.

When something extra might apply

While referrals usually aren't required for routine outpatient therapy, certain situations or specific plan variations can have their own rules (for example, some higher levels of care may involve pre-authorization). Because details vary, it's always worth confirming. The good news: you don't have to figure it out alone.

We confirm it for you — for free

When you request a consultation, we verify your NYSHIP / Empire Plan benefits for free — including whether any referral or authorization applies to your specific plan — and we bill directly. So instead of guessing, you'll know exactly what (if anything) is needed before your first session. Learn more about therapy for New York State employees.

This article is general educational information, not insurance, legal, or financial advice. Coverage and costs depend on your specific NYSHIP / Empire Plan benefits. We verify your exact benefits for free before you begin.