Looking to see a specialist aside from your primary care physician like Vanessa? Not to worry! Robert answers Vanessa’s question about which plan needs a referral to see a specialist. Learn more about the referral process.
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VANESSA: Hi. I'm Vanessa and I'm meeting with the Blue Cross and Blue Shield customer advocate to find out: Do I need a referral to see a specialist? I hurt my knee playing volleyball and my doctor says I need to see a specialist. Do I need a referral?
BCBS ADVOCATE: I'm sorry to hear that, Vanessa. Do you have an HMO or PPO plan?
VANESSA: An HMO.
BCBS ADVOCATE: In that case, yes. After you've seen the primary care doctor he or she will need to provide you with the referral to a new specialist.
VANESSA: So is that complicated?
BCBS ADVOCATE: It's really not. Your doctor will give you the name of a specialist in your health plan's network and complete the referral then all you need to do is call and set up an appointment with the specialist.
VANESSA: I may be switching to a PPO plan soon. Will I need a referral with that plan?
BCBS ADVOCATE: With a PPO plan, you don't need a referral. The main thing to remember is that choosing a doctor in your network will normally cost you less even with the PPO.
VANESSA: That's so good to know. Thanks so much for all your help.
BCBS ADVOCATE: You're welcome.
SPEAKER: For more information call the number on your member ID card or visit our website at BCBSTX.com.
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