My Advantage plan says I need a referral just to see a dermatologist. I thought PPOs didn't require that - was I wrong?

Question

Antonio Espino · Accepted Answer

You are correct. PPOs do not require referrals. But there are "office policies" that require one. The insurance company can't force the practice to not require one.

Steven Bleicher · Answer

Just because a PPO allows you to go both in & out of your Advantage plan's network has nothing to do with referrals. You're confusing two different principles here. Also, bear in mind that I know the State of Arizona backwards & forwards. That means that there are likely some states where the answer given above may be different. It would make sense to check with your Medicare insurance company or your agent.

Answered by Steven Bleicher on April 8, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Diana Garner · Answer

Some Medicare Advantage plans still have referral requirements. It is always a good idea to carefully review the plan documents to see if referrals are required.

Gary Henderson · Answer

It varies by insurance company. You would need to get an answer from them. You don't need a referral for supplement plans.

Vachik Chakhbazian · Answer

Yes, you may be wrong. some PPOs, may require referrals, even for specialists. rules can vary between different insurance companies and even between different plans offered by the same company. You might be required to use specialists within the plan's network, and some plans may require referrals to use in-network specialists.

Answered by Vachik Chakhbazian on April 20, 2025

Agent Licensed in CA, AL, AR & 22 other states

Answered by Vachik Chakhbazian Medicare Insurance Agent

Tommy Lawson · Answer

Usually, but it depends on the language of the plan you are enrolled in. Sometimes, even PPO plans, require referrals to dermatologists do to cost and, likely, something the plan feels your primary care physician could take care of.

Answered by Tommy Lawson on April 8, 2025

Broker Licensed in KY, CT & IN

Answered by Tommy Lawson Medicare Insurance Agent

My Advantage plan says I need a referral just to see a dermatologist. I thought PPOs didn't require that - was I wrong?

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My Advantage plan says I need a referral just to see a dermatologist. I thought PPOs didn't require that - was I wrong?

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