KARIN SCHEFTNER GOODFRIEND MD
Accepted Insurance for NPI 1982929931
Physical Medicine & Rehabilitation in Milwaukee, WI

Q: What managed care network types are accepted by this provider?

KARIN SCHEFTNER GOODFRIEND MD is enrolled across the following managed care network types: EPO, HMO, POS, PPO. HMO (Health Maintenance Organization): Requires receiving care through the network of clinicians and facilities, often requiring primary doctor referrals to access specialist treatments.PPO (Preferred Provider Organization): Provides flexibility to visit out-of-network clinicians without requiring referrals, though seeking care with in-network providers offers lower out-of-pocket costs.EPO (Exclusive Provider Organization): Restricts coverage strictly to network providers except for emergency situations, but generally allows seeking treatment from network specialists without an official referral.POS (Point of Service): Bridges elements of HMO and PPO rules. It generally mandates an in-network primary care physician referral for specialized services but retains partial out-of-network lookup allowances at heightened cost tiers.

Quality Rating: 80.46 out of 100 score

NPI Status: Active since April 01, 2010

Contact Information

9200 W WISCONSIN AVE
PHYSICAL MEDICINE AND REHABILITATION
MILWAUKEE, WI
ZIP 53226
Phone: (414) 805-7342
Fax: (414) 805-7348

Get Directions

Accepted Health Plans and Insurance Coverage

This registry outlines the health plan networks and insurance coverage profiles associated with KARIN SCHEFTNER GOODFRIEND MD, a practicing physical medicine & rehabilitation professional in Milwaukee, WI. Compiled from official data resources, this interface is designed to help you determine if your policy is accepted at this practice location. Currently, the provider is listed across 132 individual coverage options managed by medical networks, including networks like Anthem Blue Cross and Blue Shield, Aspirus Health Plan, and CareSource (Common Ground Healthcare). Please use the filtering dashboard below to search for your specific plan by name, narrow results by a single carrier corporate network, or toggle between plan types (HMO, PPO, EPO) to check your status before coordinating an upcoming clinic visit.

Search Insurance Plans

Filter By Insurance Company

Fitler by Network Type

Anthem Blue Cross and Blue Shield

Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000279475WI055001179475WI055001279475WI055001379475WI0550054

Anthem Bronze Pathway/Lean HSA (+ Incentives)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000179475WI055000879475WI055000979475WI055001079475WI0550042

Anthem Bronze Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055002979475WI055003279475WI055003979475WI055004079475WI0550052

Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560003

Anthem Bronze Preferred/Broad HSA (+ Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560002

Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560006

Anthem Gold Pathway/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000679475WI055002079475WI055002179475WI055002279475WI0550046

Anthem Gold Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055003179475WI055003379475WI055003679475WI055003879475WI0550056

Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560005

Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560008

Anthem Heart Healthy Bronze Pathway/Lean 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000779475WI055002379475WI055002479475WI055002579475WI0550048

Anthem Heart Healthy Bronze Preferred/Broad 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560001

Anthem Silver Pathway/Lean 4000 ($0 PCP Visits + $0 Select Drugs + Incentives)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000379475WI055001479475WI055001579475WI055001679475WI0550044

Anthem Silver Pathway/Lean 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055000579475WI055001779475WI055001879475WI055001979475WI0550050

Anthem Silver Pathway/Lean Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI055003079475WI055003479475WI055003579475WI055003779475WI0550058

Anthem Silver Preferred/Broad 4000 ($0 PCP Visits + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560009

Anthem Silver Preferred/Broad 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560004

Anthem Silver Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives)

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PARTICIPATING Tier

Accepted Plan ID Variations

79475WI0560007

Aspirus Health Plan

HMO Bronze $0 Medical Deductible

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010016

HMO Bronze 10000

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010009

HMO Bronze 7500

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010011

HMO Catastrophic 10600 with 3 free PCP visits

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010008

HMO Gold 2000

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010015

HMO Gold 2700

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010007

HMO HDHP Silver 5900

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010013

HMO Silver 6000

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010012

HMO Silver 6600

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0010001

POS Bronze 7500

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0020005

POS Bronze 8500

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0020003

POS Silver 6000

POS Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: ASPIRUSSIGN Tier

Accepted Plan ID Variations

86584WI0020001

CareSource (Common Ground Healthcare)

CareSource (Common Ground Healthcare) Bronze $0 Ded / $2500 Rx Ded

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030003

CareSource (Common Ground Healthcare) Bronze $0 Ded / $2500 Rx Ded - Vision Exam

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060023

CareSource (Common Ground Healthcare) Bronze $9600 ($45 PCP Copay)

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030027

CareSource (Common Ground Healthcare) Bronze $9600 ($45 PCP Copay) - Vision Exam

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060015

CareSource (Common Ground Healthcare) Bronze Standard $7500

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030041

CareSource (Common Ground Healthcare) Bronze Standard $7500 - Vision Exam

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060003

CareSource (Common Ground Healthcare) Gold $0 Ded

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030005

CareSource (Common Ground Healthcare) Gold $0 Ded - Vision Exam

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060025

CareSource (Common Ground Healthcare) Gold $3300

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030017

CareSource (Common Ground Healthcare) Gold $3300 - Vision Exam

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060006

CareSource (Common Ground Healthcare) Gold Standard $2000

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030043

CareSource (Common Ground Healthcare) Gold Standard $2000 - Vision Exam

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060001

CareSource (Common Ground Healthcare) Silver $4700 Ded / $5000 Rx Ded

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030023

CareSource (Common Ground Healthcare) Silver $4700 Ded / $5000 Rx Ded - Vision Exam

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060012

CareSource (Common Ground Healthcare) Silver $5000 Ded / $6000 Rx Ded

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030047

CareSource (Common Ground Healthcare) Silver $5000 Ded / $6000 Rx Ded - Vision Exam

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060011

CareSource (Common Ground Healthcare) Silver Standard $6000

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0030042

CareSource (Common Ground Healthcare) Silver Standard $6000 - Vision Exam

EPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PREFERRED Tier

Accepted Plan ID Variations

87416WI0060002

HealthPartners

NE WI Select $3,150 Plus Silver

PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NETWORK Tier

Accepted Plan ID Variations

20173WI0130033

NE WI Select $3,800 HSA Silver

PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NETWORK Tier

Accepted Plan ID Variations

20173WI0130037

NE WI Select $6,000 Standard Silver

PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NETWORK Tier

Accepted Plan ID Variations

20173WI0130034

NE WI Select $6,800 Plus Bronze HSA

PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NETWORK Tier

Accepted Plan ID Variations

20173WI0130035

NE WI Select $7,500 Standard Bronze HSA

PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NETWORK Tier

Accepted Plan ID Variations

20173WI0130036

NE WI Select $8,400 HSA Bronze

PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NETWORK Tier

Accepted Plan ID Variations

20173WI0130038

Oak $1,300 Gold

PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NETWORK Tier

Accepted Plan ID Variations

20173WI0130001

Oak $2,000 Standard Gold

PPO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NETWORK Tier

Accepted Plan ID Variations

20173WI0130011

Network Health

Prestige Bronze $0 Medical Deductible

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SIGNATUREPRESTIGEBRONZEZERO Tier

Accepted Plan ID Variations

81413WI048001881413WI0490018

Prestige Bronze $0 Medical Deductible + Dental + Vision

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SIGNATUREPRESTIGEBRONZEZERODV Tier

Accepted Plan ID Variations

81413WI0470018

Prestige Bronze $0 Medical Deductible + Dental +Vision

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: SIGNATUREPRESTIGEBRONZEZERODV Tier

Accepted Plan ID Variations

81413WI0460018

Prestige Bronze Essential + 3 Free PCP Visits

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGEBRONZEESSENTIAL Tier

Accepted Plan ID Variations

81413WI048000881413WI0490008

Prestige Bronze Essential + Dental + Vision + 3 Free PCP Visits

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGEBRONZEESSENTIALDV Tier

Accepted Plan ID Variations

81413WI046000881413WI0470008

Prestige Bronze Plus

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGEBRONZEPLUS Tier

Accepted Plan ID Variations

81413WI048000281413WI0490002

Prestige Gold

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGEGOLD Tier

Accepted Plan ID Variations

81413WI048000481413WI0490004

Prestige Gold 50 + 1 Free PCP Visit

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGEGOLDFIFTY Tier

Accepted Plan ID Variations

81413WI048001681413WI0490016

Prestige Gold 50 + Dental + Vision + 1 Free PCP Visit

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGEGOLDFIFTYDV Tier

Accepted Plan ID Variations

81413WI0470016

Prestige Gold 50 + Dental + Vision+ 1 Free PCP Visit

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGEGOLDFIFTYDV Tier

Accepted Plan ID Variations

81413WI0460016

Prestige Gold Essential + 3Free PCP Visits

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGEGOLDESSENTIAL Tier

Accepted Plan ID Variations

81413WI048001381413WI0490013

Prestige Gold Essential + Dental + Vision + 3 Free PCP Visits

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGEGOLDESSENTIALDV Tier

Accepted Plan ID Variations

81413WI046001381413WI0470013

Prestige Silver

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGESILVER Tier

Accepted Plan ID Variations

81413WI048000381413WI0490003

Prestige Silver Essential + 3 Free PCP Visits

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGESILVERESSENTIAL Tier

Accepted Plan ID Variations

81413WI048001181413WI0490011

Prestige Silver Essential + Dental + Vision + 3 Free PCP Visits

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: PRESTIGESILVERESSENTIALDV Tier

Accepted Plan ID Variations

81413WI046001181413WI0470011

UnitedHealthcare

UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0100019

UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0110005

UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0100022

UHC Bronze Standard (No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0100001

UHC Gold Advantage ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0100002

UHC Gold Advantage+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision, No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0110002

UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0100012

UHC Gold Standard (No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0100010

UHC Silver Advantage ($0 Virtual Urgent Care, $5 Tier 2 Rx, No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0100020

UHC Silver Advantage+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, Dental + Vision, No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0110006

UHC Silver Standard (No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0100005

UHC Silver Value ($0 Virtual Urgent Care, $8 Tier 2 Rx, No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0100008

UHC Silver Value+ ($0 Virtual Urgent Care, $8 Tier 2 Rx, Dental + Vision, No Referrals)

HMO Group

Market Classification Rank: Individual Coverage Framework

Assigned Option Status: NON-PREFERRED Tier

Accepted Plan ID Variations

80180WI0110004

No coverage plans found coordinating with your query criteria.

Coverage Information & FAQs

What insurance does KARIN SCHEFTNER GOODFRIEND MD accept?

This provider accepts health insurance plans managed by the following insurance companies: Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare), HealthPartners, Network Health, UnitedHealthcare. You can filter specific policies or search for unique plans using the open dashboard controls located above.

Is this provider enrolled to accept Medicare?

Yes, registry files confirm this provider accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment for covered services. Additionally, the provider is officially enrolled in the PECOS program (Provider Enrollment, Chain, and Ownership System), verifying that they are certified to order, refer, or prescribe services to Medicare beneficiaries.

What managed care network types are accepted by this provider?

KARIN SCHEFTNER GOODFRIEND MD is enrolled across the following managed care network types: EPO, HMO, POS, PPO.

HMO (Health Maintenance Organization): Requires receiving care through the network of clinicians and facilities, often requiring primary doctor referrals to access specialist treatments.
PPO (Preferred Provider Organization): Provides flexibility to visit out-of-network clinicians without requiring referrals, though seeking care with in-network providers offers lower out-of-pocket costs.
EPO (Exclusive Provider Organization): Restricts coverage strictly to network providers except for emergency situations, but generally allows seeking treatment from network specialists without an official referral.
POS (Point of Service): Bridges elements of HMO and PPO rules. It generally mandates an in-network primary care physician referral for specialized services but retains partial out-of-network lookup allowances at heightened cost tiers.