When You Need Specialist Care Using Your HMO Option
If you feel you need to see a specialist, such as a dermatologist or cardiologist, you should discuss this with your primary care physician.
Your primary care physician can make an initial diagnosis of your medical condition and direct you to the proper specialist as necessary. Also, your primary care physician knows your medical history and is responsible for the overall coordination of your care.
If your primary care physician believes that a specialist should treat your medical conditions or concerns, you will usually be referred to a specialist within your primary care physician's medical group or Independent Practice Association (IPA), once the medical group or IPA has approved the referral.
Physicians within the same medical groups or IPA have better access to your medical records and can more easily communicate with your primary care physician about your care.
If your primary care physician believes that you should see a certain type of specialist that is not in his or her medical group or IPA, you may be referred to an appropriate specialist elsewhere within our HMO provider network.
If your primary care physician believes that you should see a specialist that is not in our HMO network, you may be referred to a specialist outside the network. Your care will still be covered under your HMO option in this case.
When You Need Specialist Care Using Your PPO Option
By using your PPO option, you have the flexibility of going to a specialist without obtaining a referral from your primary care physician. You also have the option of seeing a specialist who is not in our preferred provider network.
To keep your medical costs down when you use your PPO option, it's wise to go to a specialist who is in our preferred provider network.