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Dr. Ronald Darling would like to forget the days when health maintenance organizations strictly required referrals from primary care physicians before patients could even get through his door.
And the ear, nose and throat specialist is confident he will never see those days again, not after many HMOs continue to loosen those restrictions.
Most recently, CompcareBlue, the HMO of Blue Cross Blue Shield of Wisconsin, announced in August that it would no longer require referrals for enrollees visiting in-network providers.
The decisions reflect a trend by insurers to ease "primary care gatekeeping requirements," even as some HMOs consider implementing greater restrictions on pre-authorizations for certain procedures and adding more stringent care management, according to an August article in Health Affairs, a national journal. In fact, industry observers said, CompcareBlue is among the last Wisconsin HMOs to make the referral requirement change.
"The vast majority of carriers have eliminated those" requirements, said James McCormack. chairman of Diversified Insurance Services Inc., a Waukesha insurance brokerage. "It certainly makes for good PR."
BLURRING THE LINES
It also represents a further blurring of the line between managed care and more flexible insurance options like preferred provider organizations (PPOs) - another...