Which MCO plan typically requires referrals to see specialists?

Health Maintenance Organizations, or HMOs, typically require referrals to see specialists. This is a key characteristic of HMO plans which are designed to manage costs and ensure coordinated care. When a patient needs to see a specialist, they must first consult their primary care physician who will evaluate the situation and provide a referral. This structure helps the HMO control costs and ensures that specialists are only utilized when necessary, thus emphasizing preventive care and management of health outcomes.

In contrast, other types of plans such as PPOs (Preferred Provider Organizations) do not require referrals, allowing patients greater flexibility to see specialists without prior approval. Traditional insurance and indemnity plans also generally provide more freedom in choosing healthcare providers without needing referrals, focusing instead on reimbursement after services are rendered.