How do referrals work in an HMO?
In an HMO you pick a primary care physician who coordinates your care and must issue a referral before the plan will cover a visit to a specialist.
PCPs and Referrals
A primary care physician coordinates a member’s care and, in HMO and POS plans, must give a referral before the plan covers a specialist. PPO and EPO plans usually let members see specialists without one.
Do all plans require a referral to see a specialist?
No. HMO and most POS plans require a primary care physician’s referral to see a specialist; PPO and EPO plans generally let you go directly to an in-network specialist.
What does a primary care physician (PCP) do in an HMO?
In an HMO, your PCP is the coordinator of your care; you use them for routine needs, and they must issue a referral before the plan will cover a specialist.