Navigating the System

Empower yourself as a patient, and learn how to get the most out of your benefits. Each plan is different, so this section of our guide will help you understand what it is that you should look for when you receive your insurance information.  This section will help you navigate the health care system when you need care.

Topic Area: Provider networks and referrals

My primary care doctor was out sick and someone else was covering. Am I in trouble because I didn’t get a referral?

Often, when doctors are out sick, their office staff calls to notify patients and reschedule appointments. Sometimes, instead of rescheduling appointments, a doctor may refer patients to another doctor.

If you plan to see a doctor that is covering for your primary care provider, it is your responsibility to confirm that the covering doctor is in-network before you receive care. Learn more about provider networks.

Failure to confirm that you are seeing an in-network doctor can result in limited or no insurance payment for services and high out-of-pocket expenses. If this happens, you can try to appeal the claim by following the steps outlined by your insurance company.


Was this answer helpful?