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Physician Referrals, YOU Have A Choice!

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Physician Referrals, YOU Have A Choice!

Health care and visiting the doctor has become increasingly complicated to navigate. Rules are always changing.  Life is busy which makes it hard to keep up with the changes.  Good news!  I am here to help!  So, let’s dive in!!!

Wednesday 7 6 16When do I need a referral?

Referrals are generally required when you need to see a specialist for a condition that your regular primary care physician cannot treat.  Not all specialists need a referral.  The services that DO NOT require referrals are:

  • In network:
    • Obstetrician/gynecologist
    • Urgent care centers or walk in clinics
    • Eye examinations
    • Mental health disorder and substance abuse services
    • Pathologist
    • Radiologist
    • Anesthesiologist
    • Emergency room visits/admissions
    • Non-physician services such as:
      • Outpatient labs
      • Diagnostics
      • Physical Therapy
      • Durable medical equipment

How do I obtain a referral for a specialist?

Once your primary care physician determines a specialist is needed, to help you with your condition, a referral is given.

A Referral is an authorization for you to see a specialist.

In some cases, your physician may give you a recommendation of who to see along with his referral.  A recommendation is exactly what it sounds like.  It is a suggestion of who you might want to consider seeing for treatment, not a mandate.  This is great news!  Why?  For many reasons!  Check them out:

  • Many times, your primary physician may recommend a specialist who is not in your network.  This can be a very expensive option for you.
  • You have the opportunity to research and find the perfect specialist for you within your health insurance network
  • In some cases, referrals are generated due to a quid pro quo arrangement between doctors.

Now that you have your referral in hand, it is time to select your specialist.  One of the first things you should do is fire up your computer and search for the doctor in your insurance plan’s database.  Not sure who is in your carrier’s database or where to even find the database?  No worries, use this handy tool:  Dave’s Doctor Search.  Here you will find all of the doctor’s listed in the each of the major health insurance carriers.

Select at least three specialists you are interested in possibly using for treatment and learn more about them.  Some of the things you will want to look for are:

  • Is the doctor licensed?  You can verify this by visiting your state’s physician licensing board
  • Is the physician board certified?  A board certified physician is one who demonstrates exceptional expertise in a specialty or subspecialty.  They are certified and recognized by the ABMS Member Board.  Qualifications to be recognized by this board includes rigorous testing and peer evaluations.  These evaluations and tests are engineered and administrated by other specialists in the same field of specialty.
  • Consider the age of the doctor.  Are they older and considering retirement, are they younger and have a passion for cutting edge technology and techniques or have they been practicing a long time giving them ample experience to treat your condition well?
  • Discover how long the doctor has been practicing by visiting online doctor listing sites.
  • Have there been interruptions in their practice and why?
  • What hospitals is the doctor affiliated with and how are those hospitals ranked?
  • Has the doctor experienced any reprimands or malpractice suits?
  • Consider researching doctor ratings sites and review sites.
  • Has the doctor authored any papers, studies or conducted research in the field you are looking to get treatment in?

There is so much to consider when selecting a doctor and a specialist!  The most important thing to remember is that YOU get to make the choice on who treats you.  Take control of your health and your healthcare by selecting the physician that makes the most sense for you and your health goals.

Remember, the referral you receive from your primary care physician (PCP) is the authorization you need to go to the specialist.  The name of a doctor they give is a recommendation only.  Do your homework and find the right fit for you.

Do you need help navigating your way through today’s healthcare arena?  I can help!  Contact Dave, Your ObamaCare Guy for more information at: (813) 391-3448 or email me at dave@YourObamacareGuy.com.

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One thought on “Physician Referrals, YOU Have A Choice!

  1. What do you do when you cannot see the dedicated referral doctor on your plan until after the first of the year? This is what has happened with me for an injury and it is not going to heal without seeing a specialist. That seems a very unrealistic waiting time.

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