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The member(s) are not required to use a gatekeeper or obtain a referral before seeing a specialist. In that case, the traditional benefits are applicable. If the member uses a gatekeeper, the HMO benefits are applied. However, the beneficiary cost sharing (e.g., co-payment or coinsurance) may be higher for specialist care. [3]
A specialist survey at Mayo Clinic agreed that e-consult was less disruptive than consultations by telephone or pager by 67%. And at the San Francisco General Hospital there was a reduction of 2.1% in inappropriate specialty referrals by the surgical specialty clinicians compared to 9.8% of paper-based referrals.
Doctors and Clinicians analyzed KFF data and resources from the Department of Health and Human Services to break down the common forms of insurance plans in the U.S. to help consumers navigate ...
The huisarts (literally: "home doctor") administers first line, primary care. In the Netherlands, patients usually cannot consult a hospital specialist without a required referral. Most GPs work in private practice although more medical centers with employed GPs are seen. Many GPs have a specialist interest, e.g. in palliative care.
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Open Referral in private medical insurance refers to the practice of a General Practitioner referring patients to any consultant with a particular speciality for treatment rather than explicitly naming a specific consultant. The insurance company will then choose a consultant that has the speciality specified from an approved list that they ...
There is a large volume research indicating that self-referral has a major effect on increasing medical costs in the US. David Levin estimated the cost of unnecessary self-referred imaging in 2004 to be, conservatively, $16 billion per year. [3] There are several examples showing that self-referral increases utilization and costs:
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