It also depends on your health care policy, since you live in the US. I am guessing if you have a PPO or other kind of policy, no. If you have a HMO yes. I hate HMOs. Don't get me started.
Also your state has RomneyCare, so there may be aspects to this I don't understand. AFAIK, ObamaCare (which was fashioned from RomneyCare) would not rely on so-called "gatekeepers". Not talking re: gatekeepers for hrt, but gatekeepers for specialists.
--Jay