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When you sign up for an HMO, your first step is to pick a primary care physician (PCP) to manage your care. You may already have a PCP, such as your family doctor. A child’s pediatrician and a woman’s OB/Gyn can also act as their PCP.
Your PCP will make sure you get the care you need, even when you see another doctor or go to the hospital. When you have a health issue, you’ll first go to your PCP. If the PCP thinks you need to see a specialist, they’ll arrange it for you by getting a referral.
The PCP will:
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.
Three things you’ll want to make sure happen:
It’s your right to ask questions to make sure your doctors are using your HMO the right way. If you don’t have a referral or if you have tests that aren’t a covered benefit, your HMO may not cover the costs for you.
You can get more information about your HMO health plan at any time. Just log in or register for your member account, Blue Access for MembersSM. Visit the My Coverage tab to verify your coverage.
Watch a video about how HMO referral process works:
Originally published February 17, 2015; Revised 2020
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