Question

In some managed care plans referrals to a specialist must be approved by the:

A) Primary care physician
B) Insurance company
C) Patient
D) Specialist

Answer 1

In some managed care plans, referrals to a specialist must be approved by the primary care physician.

Step-by-step explanation:

In some managed care plans, referrals to a specialist must be approved by the Primary care physician.

Managed care plans, such as Health Maintenance Organizations (HMOs), require that patients obtain a referral from their primary care physician before seeing a specialist. This referral serves as a way to control costs and ensure appropriate care.

For example, let's say a patient wants to see a dermatologist. In an HMO plan, the patient would first need to make an appointment with their primary care physician (PCP) and explain their concerns. If the PCP determines that a specialist's care is necessary, they will provide a referral, which then allows the patient to schedule an appointment with the dermatologist.