Referral

A referral is an official recommendation made by your primary care doctor (opens in new tab) to see a specialist for additional care.

If you have an HMO or POS (opens in new tab) plan, you’ll likely need to get a referral before you can see someone other than your primary care doctor. Without a referral, you may not be able to make an appointment with a specialist, or you may get stuck paying the full cost of your care.

Why are referrals such a big deal? There are two main reasons:

• Medical: Obtaining a referral means you’ve talked to your primary care doctor, so you’re less likely to receive treatment you don’t need.
• Financial: Specialist services are usually more expensive than seeing a primary care doctor. Referrals can prevent unnecessary specialist visits that add to your out-of-pocket expenses.

If you have an EPO or PPO plan, a referral is not usually required, but it’s always a good idea to start with your primary care doctor for a recommendation on where to get care.