Referrals from doctors - regarding MAPD Plans
- Thread starter JJ2713
- Start date
XpressInsurance
Super Genius
- 244
It is by plan, a lot of Humana's HMO plans don't require a referral. It also seems lot of plans for years in the NE don't require referrals. It is definitely getting more popular for HMO plans to not require referral.
Are you sure about that?
- Thread starter
- #5
That's what I figured - PPOs don't require a referral, but HMOs do.
However, as XpressInsurance said, perhaps more HMOs aren't requiring referrals?
Maybe you just pick the specialist, as long as the specialist is in the network of the HMO?
The reason I asked was because I know someone who I think has an HMO MAPD, but still doesn't need a referral from their primary doctor to see a specialist.
Now... I'm not entirely sure this is accurate because the person doesn't really know anything about the Plan other than telling me it's an HMO and doesn't need a referral. I need to find out exactly what Plan it is to make sure.
However, as XpressInsurance said, perhaps more HMOs aren't requiring referrals?
Maybe you just pick the specialist, as long as the specialist is in the network of the HMO?
The reason I asked was because I know someone who I think has an HMO MAPD, but still doesn't need a referral from their primary doctor to see a specialist.
Now... I'm not entirely sure this is accurate because the person doesn't really know anything about the Plan other than telling me it's an HMO and doesn't need a referral. I need to find out exactly what Plan it is to make sure.
Most likely he or she went to see a dermatologist or other specialist that doesn’t require a referral. Tell them to try and see a cardiologist
Devin01
Guru
- 430
Some HMO companies do not require a referal while some do, it just depends on the carrier and product. Once you start selling them it becomes easy to figure out.
Sound slike you need to explainhow med supp snad mapd plans work with your client and which MAPD plans are available in their area. Most clients have no idea how Medicare plans work.
Sound slike you need to explainhow med supp snad mapd plans work with your client and which MAPD plans are available in their area. Most clients have no idea how Medicare plans work.
fishfortwo
Expert
- 96
The five HMO plans in my area do not require referrals. Humana was the last holdout. On the first of the year they dropped that requirement.
I have a Doc and his wife as MAPD clients and till he retired he used to send me LOTS of referrals, either at T65 or if they got Medicare sooner. He was originally in a HMO-POS and when that went away I moved him to the RPPO, he’s still there.
