Great Lakes Foot & Ankle Centers

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Do I Need a Referral to See a Podiatrist?

Published on June 30th, 2021

Your insurance plan will dictate whether or not you need a referral to go to a podiatrist. In general, PPO and Medicare plans never require them. HMO plans, on the other hand, rely on primary care physicians to provide referrals to specialists. And because a podiatrist is a specialist, you’ll likely need a referral if you have an HMO and want to use your insurance.

How Can You Get a Referral to a Podiatrist?

For the most part, you only need a referral if your insurance plan is a health maintenance organization (HMO). For individuals with this kind of coverage, making an appointment with your primary care physician (PCP) is the first step in obtaining a referral for podiatric medicine.

During your visit with your PCP, they’ll examine your foot and ankle to try and diagnose the root of the problem. In some cases, your PCP may be able to provide treatment themself. But if they are unable to do so, they’ll provide you with a referral to an appropriate specialist. This could come in the form of a written or electronic referral or a simple phone call.

It’s also possible that a specialist you’re seeing will refer you to a different specialist with expertise in treating your particular ailment. Unfortunately, to have this second specialist covered by your insurance, the referral will still need to come from your PCP. However, in these kinds of situations, it may be possible to get the referral electronically or over the phone.

Although this process applies to nearly all HMOs, it’s always a good idea to consult your insurance plan to confirm its specific requirements.

Can I See a Podiatrist without a Referral?

Yes, if you don’t have an HMO, you can see a podiatrist without a referral. When you do have an HMO, you can go directly to the podiatrist. But be prepared to pay for treatments out of pocket if you do.

It’s also common for HMOs to cover emergency treatments and urgent care administered by a podiatrist or other specialist even without a referral. The same is true for behavioral health services. That said, treatment for foot pain and other podiatric issues typically don’t qualify as behavioral health services.

If you aren’t sure whether or not you need a referral, contact your insurance company or your PCP. Even relatively simple medical treatments can be expensive and we’d hate for you to have to pay out of pocket for any that your insurance could cover.

Never Put Treatment Off

The most important thing is that you get the treatment that you need. Most people don’t give much thought to their feet until they start experiencing an issue of some kind. But when foot pain strikes, every step you take can be an unpleasant reminder of their importance.

If you’re looking for a foot and ankle specialist in Racine, WI or Kenosha, WI, Great Lakes Foot & Ankle Centers can provide you with an exceptional level of care. Give us a call today to schedule an appointment or contact your PCP for a referral.

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Kenosha, WI 53142
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