Do some Health Insurance "network" plans let you see a specialist with a referral?

Question

I am looking at a United Health One and it is a "Network" plan and it say's:

Primary Care Physician (PCP) Required
No

Specialist Referrals Required
No

Out-of-Network Coverage
Yes

Answer 1

After looking at your other questions you don't have a clue what you are doing. You need to contact a local agent that can explain all of the plans to you and can take the time to make sure you know what you're getting. There is no charge using an agent; the cost of the plans are the same, and you would spend much less time using an agent than you already have trying to do "do it yourself" insurance.

Answer 2

You are looking at what is defined as a Preferred Provider Organization plan, PPO for short. PPO's base their premiums on negotiated fee schedules with physicians and hospitals that agree to be in the insurer's network. So the quality of a PPO health plan is going to be based on the size and scope of the network.



So yes you can "self-refer" yourself to a specialist. But if you refer yourself to physician or hospital outside of the network you will pay a significant penalty through a higher deductible and higher coinsurance participation. Some additional coverage such as well baby care, immunizations, physicals or preventative health will not be covered at all if you go out of network.

Answer 3

It's not an HMO so you don't need a referral. Why are you not asking your insurance broker about this? You should be buying this plan (assuming it's the best one for you) through a broker. It costs no extra, but they can help you with simple questions like this, help you find a company, a plan, help you apply, and then help you with any claim and billing issues. UHC is one of my favorites - I have it personally. They pay their claims quickly AND they answer the phone when you have questions...which is nice since I am my broker so I have to call them with questions.



And, Zarnev is spot on....when help is free, quit trying to circumvent it. Uneducated consumers buy insurance direct or through large online sites. Educated consumers realize there is no additional cost to get professional help.



Also, FYI "network" for all intents and purposes IS just like a PPO -- and they used to call it a PPO.

Answer 4

you're astounding about the approach. you're astounding you pick to do all those issues, and performance the PCP do all those issues, and that that is an extra step. you're incorrect about one element: it is not a waste of time. It reduces the type of visits to experts. you received't flow to the pro if the issue/project isn't severe sufficient to justify dealing with the approach. you received't flow to the pro if the PCP verifies that there is no project and also you do not favor to flow to a professional. now and again the PCP can deal with the project and also you do not pick a pro. finally, even if in case you do pick a pro, the PCP could verify that you do refer you to the astounding professional, so that you in reality flow to at least one professional. in case you flow no longer flow to the PCP first, you may flow to the incorrect professional. as an celebration, your jaw project may require a DMD and not in any respect a DDS, and a PCP could comprehend to deliver you to the right one. in case you went to the DDS without going to the PCP first, and the DDS had to allow you to comprehend to flow to a DMD, which could be a waste of time.

Answer 5

Yes - practically all PPO plans work that way.

Answer 6

Yes, and this seems to be one of them.