In a nut shell, I am dealing with back pain for which I have a referral to see a chiropractor. I am progressing, but I have a strong suspicion I’ve reached a plateau in my progress.
Will a HMO allow me to get a second opinion? And if so, is it as simple as having another referral written? And, will this request stop me from seeing the first specialist I’m seeing?
How does this work?
Unfortunately, this is not a question anyone can answer without knowing your benefit plan. Every HMO plan design is different. Sure there are basic designs, but employers may tweak things like co-pays, # chiropractic visits per year, deductibles, etc. to control premium costs. Even if your plan is not through your employer, insurance companies may offer several different HMO designs.
I suggest you look through your benefit materials (you should have received a member handbook or benefits summary from the HMO) or call the HMO’s customer service number with your question. If your plan is offered through your employer, is there someone in the HR department you can ask to better understand the process? Generally with an HMO, you can see specialists in the plan’s network as long as you have a referral from your primary care physician. If your doctor gives you a referral for a second opinion, this usually isn’t a problem as long as the specialist is in the network. But this is a generalization and may not be the case with your HMO.
Good luck and I hope your back feels better soon.
As Iris pointed out, without specifics on your benefit plan, you can’t really get specific answers.
However, you always have the right to visit your primary care provider, and if you truly think the chiropractic has stopped helping and you’re still in pain, this might be a good time to be re-assessed for other possible options, including referrals to other specialists, physical therapy, or whatever options you and your doctor think are necessary. You’re never married to a course of treatment just for insurance purposes. And, if you still want to see this chiropractor, as long as the referral and authorization are valid, you can. Care from other providers doesn’t affect anything.
Robin