sneakinsnake

sneakinsnake t1_iu5y3st wrote

"Many HMOs require that referrals be approved prior to any scheduled appointment with a specialist. " - https://www.bidmc.org/centers-and-departments/general-medicine-primary-care/healthcare-associates-hca/insurance-and-managed-care-guidelines

"If you have a health maintenance organization (HMO) or point of service (POS) plan, you'll probably need to go to your primary care physician (PCP) first. If they agree that you need to see a specialist, they'll refer you to one and make note of it in your medical file. Some health plans require that the referral be made in writing while others accept a phone call." - https://www.verywellhealth.com/what-is-a-referral-health-insurance-1738605

"Some health plans require referrals or prior authorization before you receive services from health care providers other than your primary care provider (PCP)." - https://content.naic.org/article/consumer-insight-understanding-health-insurance-referrals-and-prior-authorizations

"A few services require both a referral from your PCP and prior authorization from The Health Plan. This means that your PCP has to OK the service and get an OK from The Health Plan, too." - https://www.healthplan.org/for-you-and-family/tools-resources/referrals-prior-authorizations

"The term Insurance Referral refers to the permission or authorization of your insurance plan that they may require in order to see a recommended specialist, doctor, hospital, or type of treatment." - https://www.scarsdalemedical.com/patient-information/patient-forms/referrals-patient-resource.pdf

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You're right, though. Referrals have zero to do with insurance plans. 🤔

The OP had originally made the claim of "A referral is necessary to see a specialist in Boston regardless of your insurance" which isn't true in the sense that there are no Boston-specific regulations around this that I'm aware of. All I'm stating is that some insurance plans like HMOs may require a referral from your PCP before you're able to see a specialist. What's also true is that some specialists require referrals to be seen sooner or at all regardless of your insurance plan (which is what I think you're trying to say?).

Either way, if the OP has an insurance plan that requires a referral, they should get one. If their plan does not require a referral, seeing a PCP first may expedite the process in seeing a specialist sooner rather than later.

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sneakinsnake t1_iu34p98 wrote

Your original statement that a referral is necessary to see a specialist in Boston is simply untrue. I'm not sure where you heard that from.

I'm assuming your insurance plan requires a referral from your PCP to see a specialist or the specialist you are trying to see requires a referral. In either case, go find a PCP that can see you in the next day or two to get a referral. It doesn't matter who the PCP is - find anyone who looks decent and can see you as soon as possible.

https://www.zocdoc.com/search?address=Boston%2C%20MA&city=Boston&insurance_carrier=-1&insurance_plan=-1&state=MA

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sneakinsnake t1_iu32doy wrote

>A referral is necessary to see a specialist in Boston regardless of your insurance.

This isn't true.

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Go see any PCP who is able to see you in the next day or so and get a referral - don't worry about where they are.

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