Answer:

When you belong to an HMO, your choice of specialists will be limited to a group of doctors to whom your primary care physician (PCP) provides referrals. Although you'll normally be referred to a specialist who can treat you satisfactorily, a problem may arise when you would prefer to see a particular specialist who is outside of your PCP's network.

If you decide that you must see a specialist outside of your PCP's network, first ask your PCP for a referral. If your primary care physician is reluctant to provide a referral, explain to him or her exactly why you want to see that specialist. If your PCP will not provide the referral, and you feel strongly about seeing the out-of-network specialist, you have two options:

• Pay for the specialist's services out of pocket
• Change to a primary care physician who will make the requested referral (most HMOs allow you to change PCPs)

If your PCP does make the referral, your HMO can still refuse to pay for your visit to the specialist. In this case, you should appeal directly to the HMO and explain why you wish to see that particular specialist. If you are persistent, you can sometimes get an HMO to pay for a service that was previously denied. If your appeal fails, you can pay for the specialist's services yourself or see a specialist whose services will be covered by your HMO.