In a Specialty Care Physicians/Professional Providers office, who is responsible for obtaining the referral? The patient, the PCP, who?
For the HMO Blue Texas member, it is the PCP’s responsibility to initiate the referral as he/she is responsible for directing the patient’s care. In addition, it is the responsibility of the contracting Specialty Care Physician/Professional Provider to ensure the referral is in place prior to providing services. For the BlueChoice POS subscriber, it is the PCP’s responsibility to initiate the referral as he/she is responsible for directing the patient’s care. However, unlike the HMO, the subscriber does have some responsibility to make sure this referral was completed, as the subscriber may receive a reduced level of benefit if the referral is not in place at the time services are provided.
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