The short answer is...it depends.
Whether you need a referral depends on your insurance plan and the type of injury you have. Here are the basic guidelines:
When you may be able to go straight to an orthopedic surgeon:
- You have a traumatic injury that affects your orthopedic function
- You have a Preferred Provider Organization (PPO) or Medicare insurance plan
- You have a self-pay option
When you might need a referral from your Primary Care Physician:
- You have a Health Maintenance Organization (HMO) insurance plan
- Your insurance provider requires a referral
When you should see an orthopedic surgeon:
- You have an injury that causes pain or loss of function
- You have a decrease in range of motion
- You have chronic pain that lasts more than 12 weeks
- You have a soft tissue injury that doesn't improve after several days
A best practice to know is to always call your insurance provider before scheduling with the orthopedic surgeon. You can check your insurance card, visit your healthcare provider's website, or call your insurance company to find out what type of insurance you have. Then it is best to schedule with Ortho El Paso at 915-249-4000.
