Which type of insurance plan requires referrals to specialists via a primary care physician?

The type of insurance plan that requires referrals to specialists via a primary care physician is the Health Maintenance Organization (HMO) plan. In an HMO plan, members are typically required to choose a primary care physician (PCP) who acts as a gatekeeper for referrals to specialists. This structure helps manage care effectively, ensuring that patients are referred to specialists when necessary while also controlling costs for the insurer.

The referral process emphasizes coordinated care, with the PCP responsible for overseeing and managing the overall health of the patient. This often leads to a more streamlined approach to healthcare since the primary care physician is familiar with the patient's history and needs.

In contrast, other plan types such as PPOs and EPOs usually allow members to see specialists without a referral, offering greater flexibility in choosing healthcare providers but potentially at a higher cost. Fee-for-service plans also allow patients to see specialists directly, emphasizing a more open healthcare model without a requirement for referrals.