Which health insurance plan typically requires a referral to see a specialist?

The health insurance plan that typically requires a referral to see a specialist is the Health Maintenance Organization (HMO). In an HMO plan, members are required to select a primary care physician (PCP), who serves as the central point for coordinating the patient's healthcare. To see a specialist, members must first obtain a referral from their PCP. This process ensures that the patient's care is managed and that any necessary tests or treatments are integrated into their overall health management plan.

This referral system is beneficial as it emphasizes preventive care and the management of services, helping to keep patients within their network of providers. It also often results in lower out-of-pocket costs for the member compared to plans that allow direct access to specialists without a referral, as the HMO arrangement is structured to reduce healthcare expenses and streamline care.