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Specialist access may depend on referrals and networks
Specialist access rules vary. In Original Medicare, you can usually see specialists who accept Medicare without a plan referral (though some offices have policies). In Medicare Advantage, specialist access may depend on referrals, network rules, and prior authorization.
Why it Matters
A simple referral or network issue can delay care or increase costs.
Action Steps
Ask: “Do I need a referral for this specialist?”
Confirm the specialist and facility are in-network (Medicare Advantage).
Ask if prior authorization is needed for related tests or procedures.
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