Why do hmos require referrals

A referral says that your HMO plans cover 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. You can get more information about your HMO health plan at any time. Visit the My Coverage tab to verify your coverage. Originally published February 17, ; Revised All Rights Reserved.

Telligent is an operating division of Verint Americas, Inc. File is in portable document format PDF. Use the drug search tools to find out if your drugs are covered and which tier they fall under on your plan type. Tufts Health Plan has partnered with Healthwise to provide members with access to a library of high-quality content on conditions, treatments and more. Skip to main site navigation Skip to main content.

Referrals Are Central to Your Care Referrals are an important part of an HMO plan because they help your doctor keep track of the care you receive and ensure that the care is right for you. Helpful thing to know about referrals - You do not need an actual referral slip When your PCP issues a referral to see a specialist, he or she will send the specialist the referral information. Always check with your PCP before seeing a specialist Sometimes a specialist will recommend you see another specialist.

Drug Search Use the drug search tools to find out if your drugs are covered and which tier they fall under on your plan type. Read more about Drug Search. Your HMO or medical group must approve many of your services before you can get them.

Usually it is your primary doctor who gives you a referral and asks for pre-approval. Check with your HMO about its rules for referrals and pre-approvals.

Ask the plan for a copy of its Evidence of Coverage. Or look on the plan's website. Page Content. An HMO is one kind of managed care plan. Why would I choose an HMO?

You might save on costs. HMOs have established provider networks and other plan features designed to keep your costs affordable.

Be sure to look at all costs beyond just the premium related to the care you need and providers you prefer seeing. You want to have a primary care doctor who can help you manage your care. A primary care doctor can help you decide what other care you need and how to get it.

You want to simplify your health care costs. Usually the only costs you pay in an HMO are set co-pays.