Health Insurance PPO : Can I See a Specialist Without a Referral?



Understanding the benefits of your health insurance PPO plan can be confusing. First, the PPO stands for preferred provider organization. These plans were created to provide discounted coverage for patients who use doctors and treatment from a list of preferred professionals. If you need to know if you can still see a specialist without a referral you will have to consult your contract. Some will allow you to do so, while many won’t. Some many not even cover a specialist at all. That is why it is highly recommended you understand and agree with your policy before you agree to it. Health insurance plans come in many forms, and your needs should dictate the policy you ultimately choose.

Why Might You Need To Get A Referral To See A Specialist?

If your plan requires referrals then you will have to. Some plans have varying degrees of when you may need to use a referral. In general you will have to see a general practitioner in accordance with your health insurance PPO regulations so that you can get the recommendation for another doctor. There may be other factors involved as well. Some will only allow you to choose from a specialist that works with the company. Others may offer substantial discounts for using a referred specialist that is part of their network. You will need to be dutiful in your research to make sure you save as much money as possible.

What To Do If A Doctor Isn’t Covered?

If that happens you may want to consider another option. That may be using a public health center that may have a specialist, or going to a doctor that is covered. Price shopping works well for these situations. Don’t be afraid to directly consult with a health insurance broker that helped get you your policy either. If nothing covers your needs it may be time to get a supplemental policy to help your health insurance PPO plan as well. Being prepared is the best thing you can do to stay healthy.




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