Certified Financial Consultant (CFC) Practice Exam

How does a member of an HMO typically see a specialist?

1. By directly scheduling an appointment

2. Through a referral from a primary care physician

3. By obtaining an approval from the insurance company

4. Via a consultation request form

The correct answer is: Through a referral from a primary care physician

In a Health Maintenance Organization (HMO), members are generally required to establish a relationship with a primary care physician (PCP). The PCP serves as the central point of care, coordinating the patient’s overall health and treatment needs. To see a specialist, a member typically needs to obtain a referral from this primary care physician. This referral process ensures that the specialist care is medically necessary and is part of a coordinated treatment plan, which reflects the HMO’s emphasis on managed care and cost containment. The requirement for a referral helps manage the medical services provided to members, ensuring that patients do not pursue specialist services without proper justification. This system can also help in directing patients to the most appropriate specialists, thus improving outcomes and maintaining effective healthcare management. In contrast, options that suggest directly scheduling an appointment or obtaining approval from the insurance company usually pertain to other types of health insurance plans, like PPOs, where more direct access to specialists might be available.