Referral? Sorry, I have to dust the shelves.

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Referral? Sorry, I have to dust the shelves.

It’s confusing, it can be pricey, and there are several household chores you’d rather do, than deal with it… It’s your health benefits. But don’t worry, you can do this. Consider this your health benefits 101.

What is a referral?

A referral from your primary care physician may be required by your health insurance plan for specific treatments from a specialist doctor.

Facts

  • Not all types of treatment require you to have a referral.
  • Not all health insurance plans require referrals.
  • HMO (Health Maintenance Organization) and POS (Point of Service) plans generally will require a referral for certain procedures, tests and surgeries.
  • PPO (Preferred Provider Organization) plans often do not require referrals, as they allow you to choose your doctors.

 

Benefits 101: Man with son and teddy bear sleeping on bed

If you’re not sure whether a referral would be required in your situation, you can look at your health plan document.

This document is called the Summary Plan Description (SPD), which can be very helpful in determining whether a referral is needed.  

Your health insurance company has a toll-free customer service number that you may call, as well. Ask them if your visit to the specialist requires a referral.

If you know you do need a referral for a treatment from a specialist doctor, contact your primary care physician (PCP) as soon as possible. Your primary care physician will assist you in taking the next steps to complete the referral. (Example: your sports medicine doctor refers you to get an MRI, and also refers you to the specific location to get the screening.)

Benefits 101: Cartoon of doctor advising a patient on a hospital bed giving her medical referral


If you don’t know who your primary care physician is, you can:

  • Check your health insurance plan ID card. Some ID cards list the primary care physician or “primary care provider” right on the card.
  • Contact your health insurance company. Contact phone numbers are listed on your health insurance ID card or available on the insurance company’s website.
  • Ask your employer how to access your health insurance plan documents. If you have your insurance through your employer, your HR or Benefits Department may be able to assist you.

 

Benefits 101: Learn about what a referral is? No thanks, I'd rather dust the shelves

Proceed Confidently

Figuring out your health plan can be tricky, especially during fall open enrollment. There can be a lot of information to deal with in a short amount of time. The more general concepts you know, the better equipped you’ll be. You can make educated choices!

Empower yourself to proceed confidently when making these decisions. Health Benefits 101 can help you understand the basics. Recognizing your needs and preparing a bit can lead you down the right path.

We'll let you get back to dusting the shelves now.

 

 



But wait, there’s more. This is a general description of a referral but that isn’t the whole story. Check your Summary Plan Description (SPD) from your health insurance company. It contains what you need to know about the specific rules of your plan.

If you want to know about any plans or services we provide, please access your Summary Plan Description (SPD) and other helpful information by logging in. Click the “Log In” button in the upper right corner of this page, then “Participants.”

There you will also find rules and tips for your BESTflexSM Plan health care flexible spending account (FSA), EBC HRASM health reimbursement arrangement (HRA), or SimplyHSA health savings account (HSA). These benefits give you ways to save pre-tax money on your health care expenses. You can also log in to access helpful information about your CommuteEase pre-tax parking and transit benefits, as well as information for users of COBRASecure.

Not sure what plans you have? You can log in at the top of the page (www.ebcflex.com) to see all your current plans, or ask your employer.

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