PPOs: No Referrals Needed
Dictionary.com defines referral as “a person recommended to someone or for something.” By becoming a certificate holder in a preferred provider organization (PPO) for your health care, you will notice that word is complete absent from their literature.
By opting into joining a managed care PPO service plan, you will not need to get any type of referral to visit doctors either with the service network or outside of the network. Insurance coverage (at varying rates) will apply to almost all qualified medical treatment incurred.
If you have a chronic condition such as back pain or problems associated with an injury, you do not have to get a referral to see a specialist under a PPO plan. It is up to you to be your own advocate and choose either in-network doctors or out of network care providers without having to get permission from anywhere.
Within PPO plans, there are no requirements for a primary care physician that are generally in charge of the network referral process associated with managed care health networks.
A PPO will provide their members with a list of pre-approved physicians that members are encouraged to see because of the financial incentive (aka low copayments) associated with visiting them. However, members of a PPO can choose to visit any doctor they like knowing that there will be some type of coinsurance that will kick in in the future.
Payment for appointments
Since there is no referral system in a PPO, members can make their own appointments.
They are then financially responsible for meeting a deductible amount, submitting their own paperwork and then waiting for reimbursement checks to be issued by the PPO. Please note that if you opt to seek medical attention from an out-of-network provider you will be reimbursed at a lower rate.