You are here: Home Insurance Health Insurance: ... HMOs Unique ... Specialist Referrals
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

HMOs Unique Features And Lingo

Specialist Referrals

« Previous

12/12

If a Primary Care Physician (PCP)decides a member should visit a specialist, the PCP provides a Specialist Referral (also known simply as a "Referral") which permits the member to see a specialist.

Depending on the type of referral, the contract and the HMO involved, the PCP's decision to suggest a member see a specialist can be made solely by the PCP or it may need approval by a referral committee, usually a group of doctors within the practice that meet regularly to review referral requests.

Upon receiving approval, the PCP decides to which specialist a member will be referred.

The patient generally retains the right to see another doctor within the system instead of the doctor recommended by the PCP.

Many HMOs either permit multiple referrals so the member does not need to seek permission each time he or she wants to see a specialist, or have eliminated the referral requirement all together. Either of these options are particularly useful for people with a life changing condition who meet frequently with specialists.


Please share how this information is useful to you. 0 Comments

 

Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.