Health Maintenance Organization (HMO) Plans
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Do I have to get a referral to see a specialist in Health Maintenance Organization (HMO) Plans?
In most cases you have to get a referral to see a specialist in HMO Plans. Certain services, like yearly screening mammograms, don't require a referral.
Preferred Provider Organization (PPO) Plans
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Do I have to get a referral to see a specialist in Preferred Provider Organization (PPO) Plans?
In most cases, you don't have to get a referral to see a specialist in PPO Plans. If you use plan specialists, your costs for covered services will usually be lower than if you use non-plan specialists.
Private Fee-for-Service (PFFS) Plans
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Do I have to get a referral to see a specialist in Private Fee-for-Service (PFFS) Plans?
You don't have to get a referral to see a specialist in PFFS Plans.
Special Needs Plans (SNPs)
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Do I have to get a referral to see a specialist in Special Needs Plans (SNPs)?
In most cases, you have to get a referral to see a specialist in SNPs. Certain services, like yearly screening mammograms or an in-network pap test and pelvic exam (covered at least every other year), don't require a referral.
