Can I go to a psychiatrist in my PPO without getting a referral from a family physician first?

Question

I recently graduated college and started a new job 24 hours from home. My company offers a PPO plan with a network of doctors you can search through to see who they cover etc. I was diagnosed with ADHD as a child and can not be without my medicine if I want to function properly at work. I searched through the network and found a list of Psychiatrist that were covered. Could I make an appointment with one of them without first seeing a family physician? Money is a big issue for me right now, so Im trying to avoid going if I can.


any in site on this would help, Thanks!

Answer 1

As long as your policy has mental health benefits and the psychiatrist is in your PPO network, there should not be a problem. You will want to look over your benefits for find out what percentage your carrier will pay toward this care since money is an issue. Your insurance carrier should have its own website and many have member self-service where you can look up your information on-line or email the company and get an answer.

Answer 2

Check your plan! Although most PPOs don't require a referral from your primary care provider that is NOT universal! Some PPOs are more HMO-like than not and require a referral for all specialized care. Some require a referral for only certain types of specialized care. Yet others require pre-certification of need prior to going to a specialist.

The safest way to proceed would be to ask your primary care provider for a referral and check with your plan to see if a referral or pre-cert is needed.

Answer 3

yes . A PPO does not require a referral from a primary doctor to see a specialist. Good luck

Answer 4

YES.

PPOs do not require a referral to see specialists or get second opinions, however, you still need to find an in-network psychiatrist so that your insurance will pay.
Also, find out if your insurance will coner under the specialist co-pay or if they will charge a percentage, instead.

Answer 5

PPOs are not HMOs & no referral is needed. Only HMOs require referrals. If you want to be sure, just call the 800# on your insurance card & they should be able to tell you this.

Answer 6

It's possible, but it's also possible that they might not cover it. Mental health benefits are NOT built into every health insurance policy.

Seeing as how you're on current meds for it, can't your primary care physician prescribe for you, with a report/letter from your old doctor verifying the condition?? That's the easiest way out . . .

Answer 7

The PPO probably has an 800 number. I suggest you ask them.

Answer 8

Probably, but call member services (the number is on the back of your card) and double check your "mental health benefits." They may require you to pay a higher copay or something, and having a head's up about it will avoid any ugly surprises later.