Do you need a referral to see a specialist?

The answer depends upon the nature and terms of your health plan. Plans run the gamut from very limited health maintenance organizations in which you select a primary care physician where he/she has to OK all referrals to specialists, to others where you are given more latitude to seek specialized care. Most all of them allow specialized care, but have a series of approval steps that must be taken to do it correctly.

The best bet if you have a question is to contact Customer Service at the health plan and determine the proper procedure. There is likely a toll-free number on your membership card. If you do not follow the rules concerning pre-authorization, the penalty could be that the plan will not pay the charges even if they may have otherwise been covered and payable.