Can I be referred to a specialist outside my medical group as long as they’re in-network? (HMO)

I recently started a new job that only offers HMO for first year employees. I also have a complex medical condition that requires multiple specialists and not many specialists are familiar with my condition.

I found a hospital near me that has multiple in-network specialists that treat my condition, but for some reason my PCP options for those affiliated with that hospital are either out-of-network or an hour’s drive away.

My mom thinks that if I choose an unaffiliated PCP that’s closer to me, I can’t be referred to those specialists. Is that true? Her reasoning is that you can’t be referred to specialists outside your medical group but that doesn’t make sense to me. I know I can’t see a PCP outside my medical group, but why can’t I be referred to a specialist at a different hospital/medical center?

If this is the case then can I get an exception because the other specialists don’t ACTUALLY specialize in my illness? For example if my medical group has a neurologist, but that neurologist is not known to treat X illness can I see the other one that advertises that they treat X?

submitted by /u/griefandpoetry
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