How HMO Works: The Referral Process

When you sign up for a BlueLincs HMO^SM, your first step is to pick a primary care provider (PCP) to manage your care.

Your PCP can make sure you get the care you need from the right type of specialist. They can also recommend specialists that are in your HMO network to make sure your visits with the specialist are covered.

The PCP will:

• Monitor what is diagnosed and what care you get from the specialist
• Turn in any referrals needed for lab work or hospital stays

Two quick things you’ll want to make sure happen:

• Make sure the specialist is in your HMO network. Ask when the specialist’s office calls to arrange your visit.
• If the specialist orders tests or procedures, ask if they have checked to make sure all are covered. Your PCP may need to get them pre-approved. If you have tests that aren’t a covered benefit, your HMO may not cover the costs for you.   

It’s your right to ask questions to make sure your doctors are using your HMO the right way.

You can get more information about your HMO health plan at any time. Just log in to or sign up for your secure member account online or through the BCBSOK App. Download it in English or Spanish from the Apple App Store  or Google Play.