Switching from PPO to HMO but seeing a specialist

Hey guys, I’m thinking about potentially switching my insurance from a PPO to an HMO (both provided through employer). I’ve checked the HMO, and I’m like 99.99% all my doctors and PCP would be under the HMO. The only thing I’m concerned about is my specialist.

I recently found out that the at least 7+ years (much closer to 20 though, but that’s a different story) was due to a torn meniscus (no idea how or when it happened). I’m seriously considering surgery because PT did nothing and injections are doing very minimal in pain reduction. It affects my sleep schedule and restricts me from doing a bunch of things I love.

I have a follow-up appointment on 7/29 where I’m going to ask about the possibility of surgery. I’m hoping the surgery would end up happening before the end of the year. Once my left knee is done, then we have to go into investigating the right one (another set of x-rays, MRI, etc.). Open enrollment is in late October/November, and the new insurance wouldn’t kick in until January. I’m curious about how the switch would affect my specialist? Since he accepts the HMO, would I just need to go back to my PCP for a referral?

My OB/GYN is also in network. Would I need to go to my PCP for referrals to her? Or since that’s an annual preventative care visit, can I just go to her without a referral?

I’ve also never been on an HMO before. I already go to my PCP for everything and referrals because I don’t know any doctors in my area, and I wouldn’t know where to start for some problems. Is there anything I should expect under the HMO?

If you need anymore details to answer a question, please let me know.

submitted by /u/rugbycheese
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Hey guys, I’m thinking about potentially switching my insurance from a PPO to an HMO (both provided through employer). I’ve checked the HMO, and I’m like 99.99% all my doctors and PCP would be under the HMO. The only thing I’m concerned about is my specialist. I recently found out that the at least 7+ years (much closer to 20 though, but that’s a different story) was due to a torn meniscus (no idea how or when it happened). I’m seriously considering surgery because PT did nothing and injections are doing very minimal in pain reduction. It affects my sleep schedule and restricts me from doing a bunch of things I love. I have a follow-up appointment on 7/29 where I’m going to ask about the possibility of surgery. I’m hoping the surgery would end up happening before the end of the year. Once my left knee is done, then we have to go into investigating the right one (another set of x-rays, MRI, etc.). Open enrollment is in late October/November, and the new insurance wouldn’t kick in until January. I’m curious about how the switch would affect my specialist? Since he accepts the HMO, would I just need to go back to my PCP for a referral? My OB/GYN is also in network. Would I need to go to my PCP for referrals to her? Or since that’s an annual preventative care visit, can I just go to her without a referral? I’ve also never been on an HMO before. I already go to my PCP for everything and referrals because I don’t know any doctors in my area, and I wouldn’t know where to start for some problems. Is there anything I should expect under the HMO? If you need anymore details to answer a question, please let me know.
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