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Highmark Eases HMO Referral Requirements

By Staff Writer

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NU Online News Service, March 29, 2004, 11:22 a.m. EST – Highmark Inc., Pittsburgh, is easing referral requirements for members of most of its Pennsylvania health maintenance organization plans.[@@]

Starting July 1, members of most Highmark HMOs and point-of-service plans will be able to see in-network specialists without getting referrals from primary care physicians.

Highmark, which operates in Pennsylvania as Highmark Blue Cross Blue Shield, says the move will affect 850,000 HMO members. HMO members still will have to choose primary care providers, and primary care providers will be responsible for performing routine exams and routine preventive care.

The change applies to all Highmark HMO and POS plans except for the Highmark SecurityBlue Medicare HMO.