How Referrals Work

A referral is a formal recommendation from your primary care doctor to see a specialist — for example, a cardiologist or dermatologist. It often includes your relevant history so the specialist is prepared.

For some plans, the referral is also what makes the specialist visit eligible for coverage.

HMO plans usually require a referral before seeing a specialist. PPO plans often let you see specialists directly, without one.

Always check your specific plan — needing a referral you did not get can mean paying the full bill yourself.

Your PCP evaluates your concern, decides a specialist is appropriate, and submits the referral to your insurer and the specialist's office.

Once approved, you can schedule. Some referrals cover a set number of visits or expire after a period, so book promptly.

Confirm the specialist is in your network, ask how long approval takes, and keep a copy of the referral. Follow up if you have not heard back within a few days.

Bring the referral details to your specialist appointment to avoid rescheduling.

A referral is not the same as prior authorization. Some tests, procedures, or medications need separate insurer approval even after a referral.

Ask both offices whether prior authorization is required so nothing stalls your care.

A strong primary care relationship makes referrals smoother — your PCP knows trusted specialists and how to route the paperwork.

Use Hippo to find primary care and specialist providers in your network across Miami.