Why does my health plan insist that I see my primary care physician before I see a specialist?
Primary Care Physicians, or "PCP's" are an HMO based term. Meaning, that you need not go to your PCP for a referral to see a specialist. Only the HMO model will require that you first get a referral from your HMO PCP prior to being allowed to see a specialist. This is done in the hopes that the PCP may be able to deal with your issue first and thus, avoid the need to refer you to see a specialist, which inevitably would cost the insurance company more money. Thus, the insurance company set this up as a checks and balance type of scenario in that you may believe you need to see a specialist, whereas by going to the HMO PCP physician first, that physician may be able to cure or fix the problem without the need to send you to see a specialist.