Can a member with a POS plan see a specialist without a referral?

A member with a POS (Point of Service) plan generally has the flexibility to see specialists outside of their primary care network, which gives them more options when they need specialized care. However, when they choose to bypass the referral process, it typically results in higher out-of-pocket costs. This is because POS plans are designed to incentivize members to coordinate care through their primary care physician, who provides referrals to specialists. By going directly to a specialist without referral, the member might lose the advantage of lower copayments or coinsurance rates that would apply if they followed the primary care physician's recommendation.

It is essential for members to understand their plan's specific provisions, as costs and procedures may vary, but the core principle of greater cost when bypassing the referral system is a key feature of POS plans. This creates a balance between flexibility and cost management.