What type of insurance does a patient have if they must see their primary care provider for a referral to an in-network specialist?

The correct answer is the type of insurance that requires a patient to see their primary care provider (PCP) for a referral to an in-network specialist is a Health Maintenance Organization (HMO). In an HMO plan, patients are typically required to select a primary care physician who manages their healthcare. This PCP is responsible for providing referrals for specialists and ensuring that the patient receives care that is coordinated and covered by the insurance plan.

This referral system is designed to control costs and ensure quality care, as it encourages patients to receive care from within a specific network of providers. The emphasis on using primary care physicians to funnel specialized care is a hallmark of HMO plans, distinguishing them from other types of insurance.

PPOs (Preferred Provider Organizations), on the other hand, offer more flexibility in choosing healthcare providers and do not require referrals to see specialists. EPOs (Exclusive Provider Organizations) have a network but also often do not require referrals. FFS (Fee-For-Service) plans typically allow patients to see any doctor or specialist without needing a referral. Hence, the requirement for a referral to an in-network specialist characterizes HMO plans specifically.