Certified Medical Assistant Practice Exam

Which statement is NOT true about patient referrals?

1. They require preauthorization from the insurance carrier

2. They may result in additional costs to the patient

3. They can be made at the physician's discretion

4. They may be made without preauthorization from the insurance carrier

The correct answer is: They may be made without preauthorization from the insurance carrier

In the context of patient referrals, the statement indicating that referrals may be made without preauthorization from the insurance carrier is indeed not true in many cases. Typically, many insurance plans have specific protocols regarding referrals to specialists, which often include the need for preauthorization to ensure that the insurance will cover the costs associated with the referral. This requirement allows the insurance provider to evaluate the necessity of the referral and to manage costs within the network of providers. Additionally, obtaining preauthorization helps to prevent unexpected expenses for the patient and ensures that the services provided will be covered by the insurance provider. While there may be certain instances where a referral can be made without preauthorization—such as with emergency services or when dealing with out-of-network providers—these cases are exceptions rather than the rule. Consequently, the correct understanding of referrals and insurance requirements emphasizes the importance of preauthorization as a standard procedure.