No, since the City's plan is an open access HMO plan, you don't have to get a referral to see a specialist that is on the network. There are some services that require a pre-authorization, but it is your doctor's responsibility to get the pre-authorization from Mid-America Health.

If you need the attention of a specialist, your PCP will provide you with a referral. He or she will also notify your health plan, help you choose a specialist and arrange the office visit. Routine referrals are usually handled within 10 days. In urgent situations, the referral can be approved on the same day, by phone.

On a Health Maintenance Organization (HMO) plan, covered services must be provided or authorized by the member's primary care physician and received from plan (in-network) providers. A referral must be obtained prior to receiving care from specialty providers except for in-network gynecological and obstetrical visits for women and routine eye examinations. Services provided by nonplan (out-of-network) providers are not covered except for emergency care and urgent care.

For referral requirements, consult your benefit plan booklet or call Customer Service at the number on your ID card. You may choose to check your benefits online. No. Primary care physician selection is specific to each member. Selection must be made from physicians authorized in your particular network. Contact your employer for a list of primary care physicians or go to Provider Directory. Yes. You may change your primary care physician, but your health plan may limit the frequency of changes.

Yes. In some cases, a specialist may be a PCP. You can discuss this with the Customer Service Representative at the ICEB Helpline by calling 1-877-912-8880 (TTY: 1-866-565-8576). The call is free. Back to top

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).

This varies according to your plan. Please contact your customer service representative before you seek care, for the details of your plan.

The agreement between the managed care plan and your doctor is a separate agreement that may terminate any time during the year. If the provider is your primary provider, the plan must cover your care for the remainder of the plan year. If you are in your 2nd or 3rd trimester of pregnancy, the plan must cover your care through postpartum care. If you are seeing a specialist, the plan must cover your care for the lesser of 90 days or through the current course of treatment.

A referral is not required if; 1) you are more than 50 miles from the campus 2) if it is a medical emergency 3) when the health center is closed 4) when service is rendered at another facility during break or vacation periods, or for psychotherapy or maternity care 5) when injuries are sustained while participating in an NCAA sanctioned sport or, 6) you are no longer eligible to receive services at the Student Health Center. Please refer to the insurance brochure.

No, you do not need a doctor's referral to receive treatment, however, you may need one for your insurance plan or health benefits. Please contact your insurance provider or employee benefits to find out what is required.

A9. You need your doctor's (General Practitioner ?GP) referral to claim for any type of treatment, not only specialist consultants. Your doctor's recommendation is required for prescriptions, X-rays and lab tests, hospitalization and surgery. A10. Definitely, yes! Sickness and accident happen quite unexpectedly. You never know how much Health Insurance coverage you will need, until you are faced with bills.

No. You do not need to select a primary physician. However, you must seek services from a BCBSND participating provider.

Specialist services are a covered benefit under most plans, and the same Premier and PPO agreements apply. For a list of participating Premier specialists, click Find a Dentist. You may want to have the specialist submit a preauthorization to determine how much of a benefit you can expect to receive.

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.

If you want your FEHB HMO to cover your Medicare deductibles, coinsurance, and other services it covers that are not covered by Medicare, you must use your HMO's participating provider network to receive services and get the required referrals for specialty care.

To determine whether you need a referral from us before seeing a medical specialist, please view the terms of your insurance plan. Often, this information is listed on your insurance card or can be obtained by calling your insurance company. Our medical providers can refer you to a specialist if your health situation requires it or if your health insurance company requires a referral prior to visiting a specialist.

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.

This depends on your insurance coverage. Please call our office and someone should be able to answer that question, 410-332-9700. Yes, the staff of The Weinberg Center for Women’s Health & Medicine works very hard to coordinate appointments for you. Please allow as much advance time as possible when coordination is important.