What is an HMO, and what if I don’t I see in-network coverage?
HMO plans can be confusing because they limit care to a specific network and often require referrals before seeing a specialist. If you’re not seeing in-network coverage, it’s usually due to these plan restrictions — but our team can help you review your options and understand next steps.
An HMO (Health Maintenance Organization) is a type of insurance plan that requires you to receive care from doctors and clinics within a specific network. Most HMO plans also require a referral from your primary care provider (PCP) before you can see a specialist, including a neurologist.
If you’re not seeing in-network coverage with us, it’s usually because your HMO plan limits specialist visits to providers within its contracted network. Unlike PPO plans, HMOs generally do not offer out-of-network benefits, which means services outside of the network are typically not covered unless special authorization is granted.
If you have an HMO plan and are interested in care, you can contact your insurance company to ask whether out-of-network exceptions are possible, or whether a referral can be submitted. Our team is also happy to review your specific plan details and help you understand your options.