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

Question

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In an HMO, it is necessary for the member to obtain a referral from their primary care physician in order to see a specialist. If the member sees a specialist without a referral, the HMO will not pay for the service.

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