Specialist Visits – They’re Covered

In this “It’s Covered” series, we’re delving into the many healthcare services that Comfort™ covers that most traditional plans do not.


For most everyday health needs, such as routine physicals or diagnosing common illnesses, individuals can turn to their primary care provider as a one-stop shop for care and a guide on the path to health and wellness. But when more nuanced health problems come up, people often must turn to specialists for more focused care.

There are medical specialists for nearly everything. When dealing with swelling in joints, an individual may turn to a rheumatologist. If someone’s having trouble breathing, they may need to see a pulmonologist, or when someone has a family history of heart disease and high blood pressure, they may see a cardiologist to discuss their risks and preventive care.

It may seem simple enough to schedule an appointment with a specialist as soon as the need arises, but with most traditional health plans, there are usually hurdles to jump through as well as out-of-pocket costs.

Most traditional health plans require members to have a referral from their primary care physician in order to see a specialist, but with Comfort, individuals don’t need a referral to see a specialist if they’re in network. Additionally, traditional plans typically require members to pay a copay or coinsurance for a specialist office visit. A typical copay to see a specialist generally costs at least $50, if not more, and it’s usually higher than what someone would pay for a primary care visit. With Comfort, specialist visits are fully covered at no cost to the member (on top of no-cost primary care visits).

Whatever type of specialty care members may need, Comfort is designed to help them access it.

Specialty care is a wide umbrella, and some health plans may only cover certain specialties. Comfort members can rest assured that all specialist visits are covered – from cardiology to gastroenterology and every specialty in between.

But what if someone needs more than just a specialist office visit – for instance, an endocrinologist ordering blood work for a patient with diabetes? Let’s remember that when seeing the doctor, traditionally anything else during the visit like an X-ray or a special test is charged in addition to the copay, and an individual won’t be aware of this until they get a bill in their mailbox a few weeks later. These kinds of surprise bills are often what make individuals wary of going to the doctor in the first place. But with Comfort, diagnostic testing or imaging associated with an office or clinic visit is also fully covered.

In an effort to control costs, many traditional plans have measures in place aimed at reducing the number of doctor visits and healthcare services members access. Many people are discouraged or hesitant to get regular care for common health concerns because deductibles are high and they’re often required to pay copays and other out of pocket costs. This can create a situation that’s actually more costly and damaging to an individual’s health down the road.

Comfort is designed to help members be proactive about their health and take consistent steps to avoid chronic medical issues, leading to better long-term health and reduced future costs. And when someone does need to see a specialist, we’ve removed the obstacles so they can continue getting the care they need, as soon as they need it. To learn more about how you, your employees or your clients can access no-cost specialty care on day one with Comfort, contact us