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If you have an HMO you cannot self-refer to a specialist. You must first see your primary care physician (PCP) about the condition. He or she will try to treat you according to medical protocol before sending you to a specialist. Once those efforts are unsuccessful you will then be referred to a specialist. This is true for many conditions such as chronic tendonitis, knee pain, headaches, etc. However, for certain conditions such as broken limbs, post-hospitilization conditions, your PCP will refer you and treat you symptomatically until your appointment. As a side note, specialty visit co-pays are also higher than PCP co-pays.
There are several health plans (insurance companies) that allow self-referrals for certain specialties and for certain conditions. For example, a woman can self-refer to an OB/GYN for an annual well-woman exam. Contact your health plan to find out which specialities/conditions are available for self-referral.
You must try and remember that the purpose of an HMO is to provide good healthcare and contain costs. If your PCP refers you to a specialist without attempting to treat the condition first, the specialist will likely run a battery of tests that may not be needed.
What else can I help you with?
I need to know if I can see a surgeon about my neck & back, without a doctor referal?
That depends on your insurance if you have an HMO you'll need a referal without and HMO and you have regular insurance you should be ok. Though some surgeons require it even with out an HMO you need to check with specific surgeons.
Do we need a referral to see a specialist for HMO?
Yes, typically, you need a referral to see a specialist when you have a Health Maintenance Organization (HMO) insurance plan. The primary care physician (PCP) usually evaluates your condition and provides a referral if necessary. This referral process helps manage care and control costs within the HMO network. However, always check your specific plan details, as requirements may vary.
How does an HMO health insuance plan work?
"An HMO health insurance plan requires you to choose a primary care provider from doctors within your network. You will see this doctor for typical health issues. If you need to see a specialist of any kind, you must receive a referral from your primary care doctor to be covered by insurance."
Please explain the difference between HMO and PPO medical insurance plans?
With an HMO you have a network of doctors and hospitals that you can use and anyone outside of this network will not be paid for by your insurance. All of the records are centrally located and available to anyone in the network and you choose a primary physician who then can make referrals to a specialist if needed. With a PPO, there is a preferred provider netwok however you can go outside the network with reduced amounts of coverage. It is easier to get a second opinion , switch doctors and see a specialist as you have more choices. HMO's generally cost less.
What did Allison see when she threw that stink bomb?
she saw a big fat referal.
You must have a referring doctor in a?
You must have a referring doctor if you have an HMO. A referring doctor must refer you to a specialist in order for them to pay for it.
What is the deffernece between hmo and epo?
HMO (Health Maintenance Organization) and EPO (Exclusive Provider Organization) are both types of managed care health insurance plans, but they differ in provider access. HMO plans require members to choose a primary care physician (PCP) and obtain referrals for specialist care, while EPO plans do not require referrals and allow members to see any specialist within the network directly. Additionally, HMO plans typically have lower premiums and out-of-pocket costs, but they offer less flexibility in provider choice compared to EPO plans, which often have a broader network but may not cover any out-of-network care except in emergencies.
What humana plans need a referral to see a specialist?
Humana plans that typically require a referral to see a specialist include Health Maintenance Organization (HMO) plans. In these plans, primary care physicians (PCPs) coordinate care, and a referral from a PCP is often necessary for patients to access specialist services. It's important for members to check their specific plan details, as requirements may vary by plan type and location.
Is open access available with a PPO or HMO plan?
Open access is typically available with a PPO (Preferred Provider Organization) plan, which allows you to see any healthcare provider without a referral. However, it may not be available with an HMO (Health Maintenance Organization) plan, which usually requires you to choose a primary care physician and get referrals for specialist care.
Business Owners Can Offer Various Health Plans ?
A business owner can offer several types of health plans to their employees. Health plans are offered as a PPO, HMO or a health savings account. PPOs generally offer the employee more freedom to select a wider set of physicians and healthcare providers. HMOs generally keep a tighter control of operations. HMOs typically require the employee to see one primary care physician before they can see any type of specialist. The HMO must refer the employee to the specialist in order to be paid. Conversely, PPOs do not require this. PPOs allow employees to simply make an appointment with a specialist and see him/her directly. By offering both PPOs and HMOs, a business owner can accommodate employee�s individual preferences.
How do you spell referal?
Referral
If you are pregnant can you have regular medical to see a certain OB Doctor even though your medical is set just to a certain doctor?
Are you in an HMO? When you said "certain doctor" do you mean your Primary Care Physician or a certain OB doctor? Is there only ONE OB doctor on your plan? There are usually several in a medical group - IPA. If you are talking about having a Primary Care MD and then you want to see an OB Specialist in CA without getting a referral, that is your right in an HMO under the law in CA.
