This content is for general informational purposes and does not constitute medical, legal, or financial advice. Healthcare rules and costs change annually. Last reviewed: January 1, 2025. Always verify current details with your insurer, employer, or a licensed healthcare navigator.
Referral
A written authorization from your primary care doctor to see a specialist, required by some plans.
Full Definition
A referral is a recommendation or authorization from your primary care physician (PCP) for you to see a specialist or receive certain services. HMO and POS plans typically require a referral before specialist visits — without one, the visit may not be covered. PPO and EPO plans generally do not require referrals. Some plans also require referrals for specific diagnostic tests or treatments. Referrals may have an expiration date or a limited number of visits.
Real-World Example
Your HMO's PCP writes you a referral to see a dermatologist for a suspicious mole. Without this referral, your HMO will not cover the dermatology visit, and you would owe the full cost.
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