The majority of people with group health insurance coverage in the United States are covered by a health maintenance organization (HMO). This type of insurance plan is relatively inexpensive compared to others, but is often more restrictive and requires active involvement of the insured member. The need for a referral prior to a visit with a specialist is one of the most misunderstood and potentially confusing rules.
Step 1
Schedule a visit with your primary-care physician to discuss your ailment.
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Step 2
Request a referral to an in-network specialist at the conclusion of your visit.
Step 3
Obtain your insurance company's specific completed referral form from your doctor's receptionist.
Step 4
Contact the specialist's office and schedule an appointment.
Step 5
Give the completed referral form to the specialist's receptionist when you arrive for your visit.
Tip
Many referrals to specialists can be completed online by your primary physician’s office staff, leaving no chance that the forms can get lost or damaged.
You are not obligated to see the specialist recommended by your primary-care physician. Contact your health insurance carrier for a list of other qualified specialists who will accept your health insurance coverage.
Warning
Some specialists insist that you provide a paper copy of the referral form and will refuse to see you without it.
Most referrals have an expiration, and if you do not visit with the specialist within the allotted time you must return to your family physician to request another.
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