If a member in a health maintenance organization (HMO) sees a specialist without a referral from his or her primary care physician (PCP), the HMO will not pay for the service.

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Quizplus · Accepted Answer

This is a common requirement in HMOs, where a PCP acts as the gatekeeper for all medical services needed by the member. If a specialist visit is necessary, the PCP must provide a referral for the HMO to cover the cost.

If a Member in a Health Maintenance Organization (HMO) Sees