Question:
Do you have to have a referral if you have a PPO?

i just talked to the nurse at the doctor`s office i want to do my surgery and i was told that because i have a ppo i dont need a referal has any one else not had to go to a pcp i will have bc/bs care first.    — rochele1970 (posted on March 11, 2002)

March 11, 2002
I didn't have to get referal and I also use BCBS PPO. The whole advantage of PPO over HMO is you can go to anyone in or out of the network that you chose to go to. PPO just offers more coverage if you use the network. Because of this you do not need a referal to anyone.
   — Cheryl S.

March 11, 2002
You do not need a referral with PPO, just make sure the Doctor you're seen in IN Network, my out of pocket expense for the whole surgery was 97 Dolars!!!!!!! you can't ask for less.
   — Monica J.

March 11, 2002
Yeah, I learned this one the hard way. I have Kaiser PPO and wasted a month waiting for an appt. with my PCP when it turns out I didn't need it at all. Oh well, gave me plenty of time to research/reinforce my decision...Good luck! RCM
   — rebeccamayhew

March 11, 2002
you do not need a referral, however you do need pre- authorization. i didn't understand the difference at first. this still needs to be approved by blue cross med rev, before you can have the surgery.it took me about 30 days, before i was approved. good luck.
   — lynette Z.

March 11, 2002
I have a PPO. I don't need a referral but I do need to be pre-authorized with a note that gives diagnosis of MO and stating that the surgery is medically necessary. I have been approved for the in-patient portion but I need to get authorization for the doctors to be paid. The best thing to do is call your insurance company directly. Some plans have an exclusion clause and will not cover it at all. Some will cover after a "review" which is what my plan states. It all depends on your plan coverage. Call and ask.
   — Traci B.

March 11, 2002
i have bc/bs ppo. u do not need a referral for ANY dr from ur pcp. u can choose who u like. but, as monica stated...be very sure that u choose a network dr...a PREFERRED network dr i want to add. a PREFERRED network dr has to accept the payment he receives from bc/bs & cannot hold u responsible for any balance. make sure he uses a PREFERRED network anesthesiologist too. & hospital! my surgery cost us $260.oo. $100 was my deductible & the $160 was because i requested a private room so hubby could stay with me. it sure beat the $7000 the first surgeon i saw asked for.
   — sheryl titone