Referrals are required by many health insurance companies if you wish to receive specialized treatment or services. Your primary care physician is typically the person who refers you to other doctors and without her blessing you may find the going rough. Knowing how to approach your doctor when seeking a referral and what to do if she is not willing to comply is an important part of finding the proper care.
Call your regular doctor, mention the issue and ask for a referral to a specialist. Sometimes your doctor will suggest that you see a specialist on her own. Most doctors are aware that a referral is needed for your insurance company to cover the cost of such an examination and the treatment that may follow.
Write a letter stating your desire to visit a specialist or to have a certain type of medical exam that your doctor cannot perform herself and that will require a referral for your insurance company to make payment. Spell out all the details of your request and pay special attention to why you require the treatment and why you are unable to move ahead without a referral from your primary care doctor. Deliver the letter to your doctor and request a response in writing.
Search for a new primary care doctor and make the change. Explain your prior experience and current concerns during your first visit with the new doctor and make it clear that a referral will be your first priority. Your willingness to change doctors may demonstrate your intent to obtain the relevant referral and streamline the process with your new doctor. Bring the request and response letters from your last doctor with you and allow the new doctor to review the history of the case if necessary. Transparency is the best method to earn the trust and the assistance of your new doctor.
- Some doctors and medical offices are equipped with the diagnostic machinery or laboratory facilities necessary to perform self referrals. In this case, your doctor may recommend a procedure that she can perform in the office since it means more income for the office and an easier referral process.
- If you are unable to find a doctor willing to make the referral you need, consider making an appointment with the specialist you wish to see and making the payment out of pocket. While the cost may be high, your health is always more important. If the specialist finds a legitimate problem, bring the proof to your primary care doctor, who may then refer you to the specialist so that your insurance will cover any future costs.
- Referrals for special care or medical testing will require a second copay and a visit to both the specialist and the referring doctor.
- Referrals from one doctor to another can often involve kickbacks or other incentives paid to the referring physician. If you ask for a referral or if your doctor volunteers one, she may work from a list of colleagues with whom she has established relationships. These relationships can involve a financial element. If you have a certain specialist in mind, insist on your preferred provider to avoid being taken advantage of.
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