The EPO ("Exclusive Provider Organization") plan is set up to allow the PCP to direct the care of all members who sign up with them. If the PCP feels he/she cannot provide the care needed to the patient, approval of a Specialist visit is part of their responsibility in caring for the patient.

HMOs typically offer a comprehensive array of benefits with a Primary Care Physician who coordinates and monitors your health care needs. If you want to see a specialist, then your Primary Care Physician determines whether you should be referred to a network specialist to receive benefits under the plan.

If you are in a MO HealthNet managed care health plan, you should check with your primary care provider (PCP) or your MO HealthNet managed care health plan. If you are MO HealthNet fee-for-service, you should check with the provider you want to see. The MO HealthNet fee-for-service programs do not require a referral but the provider may require one. Your provider should know if your procedure has special rules.

When your PCP refers you to a network specialist, you receive in-network benefits for covered services. Because you may choose at any time to seek care outside the network, your PCP's referral to a network specialist notifies Blue Cross and Blue Shield that your visit to the specialist has been authorized, and to pay your eligibility claims in-network. Without the referral, your claims will be paid out-of-network, even if the specialist or hospital is a network provider.

Not necessarily. Any patient can call the office and make an appointment. Only a few insurance companies require a referral from the primary care physician. You may call your primary care physician or your OBGYN specialist and request to be referred to a Board Certified REI (infertility specialist). Recent studies have shown that smoking significantly diminishes both female and male fertility potential.

No, you may self refer (go on your own) to Alamo Mental Health as this benefit does NOT require a referral from your Primary Care Physician. WellMed Employee Health Plan's Behavioral Health Benefit is provided and managed by Alamo Mental Health. Their phone number is (210) 614-8400.

In most cases, going directly to a specialist without a referral is not covered. Your child receives benefits only for covered services given by the PCP or through referral by that doctor. There are a few exceptions. See the table below for services your child may access directly from a HIP participating physician without a referral from the PCP.

A33.Your PCP may refer you to another doctor if you need special care. Your primary care physician must OK all the care you get except when you have an emergency.

Answer: Generally, only HMO and POS insurance plans require PCP referrals. To request a specialist referral, call our main number at 615-342-5900 and select option 4 for referrals. Same-day referrals are difficult to process so please call in advance. Remember, referrals are often limited to a specific timeframe and number of visits so monitor your specialist visits as closely as possible.

Depending upon your insurance company requirements, you may need to see you Primary Care Doctor (PCP) before you can make an appointment with a specialist for your child. We participate with over 200 different insurance companies. Each insurance company has different requirements on how to obtain specialist care. Some require a referral or a precertification form to be completed (a form that must go to your insurance company to have their approval before a specialist may see you).

Except for in-network gynecological and obstetrical visits for women and routine eye examinations, your PCP must refer you to a plan specialist for a specified number of visits within a specified length of time. If you have a referral and need other treatment by a specialty provider, your PCP must be contacted for a new authorization number. It is the member's responsibility to obtain a referral authorization when required prior to receiving services from a specialty provider.

If your insurance carrier requires that you have a referral to visit our office, it is your responsibility to obtain that referral. Please make sure that all referrals are received by this office before the time of your appointment. Referrals made by the Hand and Upper Extremity Center of Northeast Wisconsin, Ltd. for tests, evaluation, or services to be provided to the patient by other providers are the full financial responsibility of the patient.

You do not need a referral for most in-plan specialty services. Just make your appointment, present your HNE ID card, and pay your usual copayment. You need a referral for specialty care only when you need the following services: