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Some health care plans require a physician referral before you can see a specialist. But how do you approach your doctor about getting a referral? You might be surprised to learn that it's actually an easy process. In fact, with so many health care changes recently, many doctors expect you to ask for a referral. But there's no reason to feel anxious or uncomfortable about this process.
Which Plans Require a Physician Referral?
Whether or not you'll need a referral depends on what type of health plan you have. Typically, PPOs and EPOs do not require a referral to see a specialist. However, if you're seeing someone who is out of your network, you'll need an OK from your insurance provider first. HMOs, meanwhile, always require a referral from your primary care physician before you can see a specialist. There's also a Point of Service plan that often requires referrals. Some health plans may vary a bit from these general practices, so before seeing a specialist, check with your insurance provider.
Other Times You Might Want a Referral
Even if your health care plan doesn't require a referral, you might still want one. If you have a great relationship with your primary care doctor and trust his or her opinion or want them involved in your continued care, then you might seek a referral. You also might have a special situation where a referral would be helpful. For example, if you have financial need, your doctor might be able to recommend a specialist who provides a great payment plan. Or you might need a specialist but you're also interested in a holistic approach. Your primary care doctor may know specialists who focus on your interests.
Questions to Ask When Getting a Referral
In order to help the referral process go more smoothly, here are some questions you can ask your doctor when you need a specialist:
- Can you refer me to multiple doctors so I can research and pick the one who's the best fit?
- Is this doctor in-network with my health care plan?
- What should my next step be? Will your office call the specialist about scheduling an appointment, or will I need to call?
- Where is the office? (You may want to request a doctor who is closer.)
- How long do patients typically need to wait for an appointment? (Some specialists are worth the wait, but sometimes time is of the essence.)
- Should I make a follow-up appointment with you after I see the specialist?
Remember: Some primary care doctors actually prefer that you come to them with your own specialist in mind. Ask if this is the case before your appointment. Your doctor might want you to come with a list of specialists who are in-network and accept your health insurance.
Do Your Own Research
Don't just rely on your doctor to find the right specialist; do your own research, too. Just because a doctor refers you to someone doesn't mean you have to go to that doctor. And just because your doctor recommends someone doesn't mean that specialist is necessarily the best. Sometimes doctors don't always know the specialists and may pick someone based on who's in-network or how much they charge, among other factors. So after you get a referral, research the specialist online. Read reviews and see what other people think. Call the office and find out when their next available appointment is. If the reviews are bad or if the wait for an appointment is too long, you can always go back to your doctor and ask for someone else.
You're the patient, so your needs are most important. If anything you find out later makes you uncomfortable, you can always ask for a referral to a different specialist. Or if you have an appointment with the specialist and don't like him or her, you can go back to your primary care doctor and ask for someone else. After your appointment, don't forget to pass along what you've learned if you can. Leave reviews online and let your primary care doctor know how it went. Your experiences may help your doctor know who to refer other patients to in the future.