Final answer:
In insurance plans, if the primary care physician makes a referral out of the network, the insurance may cover the costs. However, self-referrals can lead to coinsurance payments. Deductibles, copayments, and coinsurance are are forms of cost-sharing in health insurance policies.
Step-by-step explanation:
If the primary care physician makes a referral out of the network for a Point of Service (POS) plan, the plan pays all or most of the bill. If you refer yourself to a provider outside the network and the service is covered by the plan, you may still have to pay coinsurance.
Many insurance plans, including HMOs and POS plans, require various forms of cost-sharing, such as deductibles, copayments, or coinsurance. A deductible is a fixed amount you must pay out-of-pocket before your insurance starts to cover costs. A copayment is a set fee you pay for certain services. Coinsurance is a shared cost between you and your insurance company, usually a percentage of the service cost.
In the case of out-of-network referrals, if the referral is not made by the primary care physician, the policyholder may face higher out-of-pocket expenses due to coinsurance rates or full responsibility for the cost if the service is not covered at all.