Managed care plans are handled very differently than many other health care plans. When you want to see a specialist, you must go through a very strict process to get the specialist referrals. Once you go through the right process, all medical bills are handled by your plan and should never come directly to you. When you are under a managed care plan, you will see your family doctor for everything. If at any time your doctor feels that you should see a specialist, a benefit inquiry must be submitted. This will tell the doctor's office what is specifically covered under your plan to avoid unnecessary medical bills on your part.

The benefit inquiry is the first step in getting specialist referrals. Until the inquiry comes back, you cannot see a specialist unless you're prepared to pay for all of the services out of your own pocket. Once you get the approval, the referral is sent to your home from your insurance company. Until you get this slip of paper, you shouldn't contact any specialists, even if it means making an appointment. When you get the approval by mail, you have the authorization from the insurance company as well as your doctor. This referral must be presented when you go in for service.

To make the whole process easier, you will determine who your PCP or primary care physician is as soon as you get a managed care plan. Depending upon the company you go with, you'll have a large number of doctors in your area to choose from. Then make sure that your doctor is aware of the type of plan that you have when it comes to selecting referrals so that they can ensure that you're not spending any necessary money out of pocket. The last thing you want to do is get medical bills sent to your home because you didn't follow the procedures. As long as you always wait for the approval before contacting specialists, you will have the bills covered.

If for any reason you still get medical bills sent to your home, it's important not to throw them out. You can either forward them to your insurance company or submit them to your doctor's office. Your doctor's billing department should act as your liaison between you and the insurance company so that you don't have to have direct communication.

Specialist referrals are a necessity with managed care plans, but they help to keep your costs low. If you follow the procedures in place, you can get all the necessary care you need without spending anything extra out of pocket to get it.