Do you have a primary care provider? This is the doctor who you see for regular check ups, for medication consultations, and who you go to when you need care for a non-emergency injury or illness.
Some insurance plans require you to have a primary care provider to guide all of your healthcare utilization. Sometimes this is referred to as a ‘gatekeeper’ approach. On plans like these, you have to seek care from that primary care provider for them to refer to you a specialist if necessary.
For example, if you experience illness or injury, you would first make an appointment to see your primary care provider. If they can diagnose and treat the symptoms they will do so, and save you the expense of seeing a specialist. If the diagnosis OR the treatment is out of their realm of expertise, they will write you a referral to an in-network specialist and submit the referral to your insurance. Once you have the referral paperwork you can proceed to make an appointment with the specialist.
On other plans, you can self-refer and save yourself a trip to your primary care provider if you prefer to go directly to the specialist. Note that, while some insurance plans don’t require referrals, some medical facilities may require them anyway as part of their practice policy.
