A process by which a member’s primary care practitioner (PCP) directs them to other providers, usually specialists, for further care. Some health plans require you to get a formal referral from your PCP before you see a specialist or other type of provider. (Please note, a doctor suggesting the names of other providers is not the same thing as a formal (usually written) referral.)
Healthcare and health insurance definitions.
The processes an insurance company uses for reviewing and authorizing referrals to specialist physicians or other types of providers by primary care practitioners.
Services designed to help you maintain, regain, or improve everyday skills affected by an illness or injury. See ACA Uniform Glossary
A rider is an amendment to an insurance policy. Some riders will add coverage (such as adding a dental rider to a medical policy), while some riders exclude coverage for a certain service or condition.