Medical procedures and services can
be expensive especially if your doctor is not contracted with your health
insurance carrier. With all the changes
in health care plan options, employees sometimes get stuck with medical
expenses because they did not follow the rules of the HMO plan. Here is a great refresher for using the
referral services of the HMO plan.
Knowing your health insurance plan
and which providers you can and cannot see is a great way to keep your medical
costs down. If you are currently
enrolled in a HMO plan, you are required to select a primary care
provider. A primary care provider is a
doctor who you will see for your annual physical, sick visits, or any injuries
you may have throughout the year. Your
primary care provider is the one who will determine if your illness or injury
is severe enough that it would require you to see a specialist.
In a HMO plan, you cannot see a
specialist without a referral from your primary care provider. If you went to a specialist without a
referral, you would be responsible for the full cost of the appointment. If your primary care provider determines you
need to see a specialist, he or she will refer you to a specialist who is in the
network. By referring you to a
specialist who is in the network, this allows you to only be responsible for a
small copayment for the appointment. Typically,
the primary care provider is responsible for coordinating the referral with the
health insurance company and the referring doctor. Members who are new to HMO plans may think
they can go to any doctor they want.
However, if they choose a doctor who is not in the network or receive
care from a specialist without a referral, they will responsible for the full
cost of the appointment or procedure.
To learn more about HMO plans &
referrals and how they work, feel free to contact our office at (978)-777-6554.
Thank you.
