Frequently Asked Questions

How can I ensure that I will be referred to a specialist?

Whether or not you will be referred to a specialist depends on your primary doctor and what kind of health insurance you have. Your ability to see a specialist without a referral can vary from policy to policy. Preferred provider organizations (PPOs) generally allow you to see a specialist without a referral from a general practitioner (GP). A Health Maintenance Organization (HMO), on the other hand, will require you to receive a referral before the plan will pay for the specialist. Indemnity plans offer the greatest flexibility, but also involve more paperwork. Because you're not in a network, you are able to see any doctor and are not required to have a primary care physician. Before your plan kicks in, though, you'll have to pay your own medical bills until the annual deductible is met. You may be required to pay upfront for health services before submitting a claim. Point-of-service (POS) plans will allow you to see a specialist "out-of-network," though you'll have to submit a claim, and the percentage of reimbursement will vary from plan to plan.

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