Since I belong in an HMO, I can’t see a specialist outside of my provider network. Is there any way that I can do so?

It is crucial to understand that when joining an, your choices regarding seeing a specialist are limited. However, sometimes the specialists that are in your provider network might not suit you, and problems can occur. If you do want to see a specialist that is outside of your provider network, then you would probably have to ask our primary care physician for a referral. If your PCP (primary care physician) is hesitant to give you this referral, thoroughly explain why you would like to see this specialist.

If your PCP refuses to provide you the referral, and you strongly want to see this specialist, there are two options that you can choose from:

• Change to a primary care physician who is willing to make the change requested by you
• Pay for the services of the specialist yourself

If, for example, your PCP does provide you with the referral that you requested and if the HMO refuses to pay for this visit to the specialist\ then you should probably appeal directly to the HMO and thoroughly explain why exactly you want to see that specialist. If contacting the HMO directly fails, you will have to choose from the two options listed above. Keep in mind that when belonging in an HMO, the freedom of choice isn’t really available.

You have to see the specialists that are only in your provider network, and requesting a visit to a specialist outside of this network is not an easy job. Even though most HMOs will probably agree to pay for a visit to a specialist outside the network, there is still a possibility that this might not take place. Contacting your HMO directly in order to request for a visit to a specialist outside of your provider network is highly recommended.