Can I see a specialist without a referral?

Can I see a specialist without a referral?

Your doctor keeps track of all your medical records and provides routine care. In order to see a specialist, you’ll need a referral from your primary care physician, except in an emergency. Without a referral, your insurance won’t cover the cost of your care.

What type of plan needs a referral to see a specialist?

A POS (or “point of service”) plan is also a hybrid of an HMO and PPO plan. Like an HMO, you will need a referral from your PCP in order to see a specialist.

Who makes referral for patients in an HMO?

primary care physician
Blue Care Network members. When you have an HMO plan, a primary care physician, or PCP, is your first point of contact for care. If your PCP can’t provide the care you need, he or she will give you the name of a doctor who can. That’s called getting a referral.

Does Aetna HMO require referrals for specialists?

Health insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company (Aetna). Here’s one that lets you visit any doctor in the Aetna network. And you do not need a referral when you visit one. You don’t have to choose a primary care physician (PCP)* either, but you may want to.

Do I need a referral every time I see a specialist?

There’s nothing to stop you from seeing a specialist without a referral, but the problem is that you will be responsible for the full cost of the visit. The insurance company will not cover it.

Can I go straight to a specialist?

If you are concerned about a medical issue, you may be tempted to skip your primary doctor and go straight to a top-notch specialist, but experts don’t recommend it. “Primary care really is the best thing,” notes Matthew Burke, MD, a practicing family physician in in Washington, DC.

How do I see a specialist sooner?

Here’s how to see your doctor sooner.

  1. Book online.
  2. Call during slow times.
  3. Try the newest doctor in a big group.
  4. Ask to be on a wait list.
  5. Be nice to nurses and receptionists.
  6. Don’t fib and fake an emergency.

Do all HMOs require referrals?

HMOs generally require a referral for every specialist you see. HMOs offer low-cost care if you see a network doctor.

How long are Aetna referrals good for?

1 year
Referrals are valid for 1 year, and the first visit must be used within 90 days. A diagnosis code isn’t required; however, it’s very helpful for the specialist. Direct access: Referrals aren’t required for routine eye care and ob/gyn services.

How do I send a referral to Aetna?

Visit to check if a service requires precertification. To request a referral, you must be: A participating Aetna provider designated as a PCP – Note: The PCP making the referral must participate in the member’s benefits plan.

What happens if you don’t get a referral from an HMO?

If you don’t have a referral or if you have tests that aren’t a covered benefit, your HMO may not cover the costs for you. If you are getting ongoing treatment for a health issue, your PCP will put in a request for a standing referral.

What kind of Doctor do I need to sign up for an HMO?

When you sign up for an HMO, your first step is to pick a primary care physician (PCP) to manage your care. You may already have a PCP, such as your family doctor. A child’s pediatrician and a woman’s OB/Gyn can also act as their PCP. Your PCP will make sure you get the care you need, even when you see another doctor or go to the hospital.

How to check if my HMO plan is covered?

You can also check yourself by calling your medical group. The referral says that your HMO plan covers some or all the costs for covered services. If the specialist plans a lot of tests or procedures, ask if they have checked to make sure all are covered.

What happens if your doctor leaves your HMO?

If your doctor or other health care provider leaves the plan, your plan will notify you. You can choose another doctor in the plan. If you get health care outside the plan’s Network , you may have to pay the full cost. It’s important that you follow the plan’s rules, like getting prior approval for a certain service when needed.