Is it true or false that in an HMO, patients can see a specialist without a referral?

• A. True
• B. False
• C. Depends on the insurance policy
• D. Only in emergencies

Answer: (B)

In a Health Maintenance Organization (HMO), patients are generally required to obtain a referral from their primary care physician before seeing a specialist. This is a core feature of the HMO structure, which emphasizes coordinated care and cost management. The primary care physician acts as a gatekeeper to ensure that specialists are used appropriately and that the patient receives necessary care in a structured manner.

While certain exceptions may exist, such as for emergency situations or particular policies that might allow direct access to specific types of specialists (like obstetricians or gynecologists), the standard protocol in most HMOs is that patients must first consult their primary care doctor to get a referral. Thus, the answer is indeed false, as patients cannot typically see a specialist without this required referral in a standard HMO setting.