Here in Canada we have to get a referral from our primary care provider if they think we need to see a specialist (neurologist, rheumatologist, dermatologist, etc). However, I’ve noticed that when people ask for advice about a medical issue, the advice is often something along the lines of, “you should make an appointment with a [specialist].”
Of course I can’t know that those person offering advice are all Americans, but I do know that if I were offering the same advice as a Canadian I would phrase it differently (“Go ask your doctor if they can refer you,” for example.)
Just a silly little question, but I’m curious! Thanks
38 comments
Some insurance plans require this. Others (like mine) do not.
I just call and make an appointment. I pay a $20 co-pay to visit one.
Depends on your insurance company, some will allow it, some won’t.
I generally ask my doc for a recommendation, but I don’t think its required.
It depends on the insurance policy. I do not need a referral on mine.
A referral is usually required when the insurance company wants justification for seeing a specialized doctor. I see it as a barrier to healthcare, and invasive – if I want to see a urologist to get a vasectomy, I shouldn’t need my primary care physician’s permission. Lucky for me my policy will cover visits to a specialist without a referral.
It really depends, my insurance doesn’t require a referral
Depends on insurance and the office policy. Some docs only go by referral regardless of how you’re paying
Some specialists require referrals regardless of insurance.
It depends on the type of insurance plan / policy. My company offers several different plans with different premiums. Some of the plans require pre-authorization before seeing a specialist. Some don’t.
My policy, a PPO, doesn’t require referrals, though it does require advance authorization for some procedures.
It’s not required by my insurance to get a referral. My co-pay is about $10 more vs a PCP.
HMO’s generally require a referral (and have cheaper premiums). PPO’s generally don’t require referrals.
Depends on your insurance company and plan. Some require referrals, some allow you to just go see a specialist.
Depends on your insurance plans, some require you to get a referral and some let you just make your own specialist appointments.
I have had a variety of insurance plans and have always been able to self refer. The one example I can think of recently was ENT, where they asked me to get a referral, so I emailed my GP and she emailed it over the same day. But this year I have self referred to developmental pediatrician, pediatric neurologist, physiatrist (pm&r), sports medicine, and derm, for example. Also, unlike in UK (not sure about Canada), pediatricians and OBgyns are considered primary care in my experience.
Yes, especially if you don’t use insurance.
Sometimes! It depends on your insurance and the specialists themselves. Some specialists require referrals, some insurance plans require referrals, but everything varies.
Depends on the insurance plan. I have a PPO plan which I believe means I can go to a specialist at my leisure. I’ve gone to specialists like dermatologists before without referrals.
It depends on the healthcare company I’m sure, but in my experience, no for most specialties. You almost certainly can self refer to an OB/Gyn most places, but I’ve never seen people be able to self refer to say a nephrologist. Generally family medicine/primary care, pediatrics, OB/gyn and emergency medicine will be the only kinds of doctors you can see without a referral.
I think when people recommend that course of action, they either have an unusual insurance set up, haven’t had to see non-primary care specialists themselves and don’t know the process or they’re condensing “talk to your primary care doctor and see about getting a referral to a specialist” into “see a specialist”. I’ve accidentally called offices of specialists before a referral went through and have been told “no, we won’t schedule you until we receive a referral from your primary care doctor”.
My current insurance plan does not require me to get a referral from my primary care physician when I need to see a specialist. That’s not the case for everyone, though.
My insurance company doesn’t require a referral to a specialist, but many do.
I’ve never had an insurance plan that required a referral no.
HMO(health maintenance organization) insurance plans generally require referrals and PPO insurance plans generally don’t (preferred provider organization.)
Yes, I can. I got an appointment in one day last summer.
My Canadian friend told me the saga of how Canadian doctors didn’t take her concerns about her child’s breathing problems seriously, For Years, and it turned out the kid has cystic fibrosis.
I’ve never met a Canadian who didn’t complain about their health system.
As others have said, some insurance plans allow this, some don’t. Mine does.
HOWEVER, some specialists around me will not book appointments with self-referrals. They require a referral from a primary care provider (referral from a different specialist is 50/50). The real annoying ones require a referral from a primary care provider in the same hospital group.
I had to get a primary care doctor just to be able to access a psychiatrist in a timely manner. I’ve taken a lot of different psych meds, and have a family history of medication-resistant mental health issues, so it really wasn’t care a GP could provide and I wouldn’t trust them to do it anyway. The GP talked to me for about 30 seconds and was like “Yup, you’re going to be an emergency referral”.
My insurance allows self-referral but things go more smoothly when I go through my GP.
Sure. It’s usually easier to get referred by your GP, and insurance plans sometimes require this, but it’s not at all required. In fact, I recently reached out to a physical therapist on my own to address my neck and back issues.
Not always, there have been times I’ve gone to a dermatologist, orthopedist, etc. on my own accord without a referral. Sometimes it’s not an insurance thing but if a specialist is niche enough they will expect a referral and justification from your PCP to schedule, so it’s more of a bandwidth thing
It could be either way, I think the government plans like medicaid/care and military are a little more restrictive on needing referrals but I’ve always just made my own appointments but it’s always been simple things like scheduling a vasectomy and having a couple moles removed and tested.
Like everything in the US, it depends. And like everything healthcare related, it depends on your insurance and the provider.
Some insurances, require you to get get a referral some don’t. Some specialists require a referral while other’s don’t.
In general, I’ve never needed to get a referral to anything but I’ve heard of people having to a few times.
I cannot. I must see my primary care physician and then they must agree with my own opinion that I need to see a specialist. If they do not agree then I need to change primary care (to one of the handful I am permitted to choose from) and try the next doctor.
Depends on your insurance. I can self refer, yes
I can with my insurance. No referral necessary. I think it tends to be crappier insurance that requires a referral.
I do require a referral but my doctor is lazy. I just call and tell him who I want to see and he makes it happen.
Hm, apparently unlike most people, I *usually* need a referral. I have Kaiser, which is an HMO, and if I want to see a specialist I generally have to go to my primary care physician and run it by her first. If I feel it’s fairly urgent I try to do a video or phone appointment though, I can usually get those really quickly and then I get a call from the referring department to make an appointment the same day.
For some things like mental health or gyn, I can do those directly, no referral needed.
It depends on your health insurance and in some cases the specialist. Some insurance requires referrals for all specialty care, some doesn’t require it at all, some requires it for some things but not others. And some specialists won’t see you without a referral.
It depends entirely on your insurance plan.
If you’re completely self-pay, of course you can. . .but that’s expensive enough that very few do this.
Some insurance companies require a referral, some don’t. Even if it’s not required, it can be helpful to get a referral because, in my experience, specialists will be more accommodating with scheduling if a referring physician says this person needs to be seen promptly rather than some random person asking for an appointment.
It’s usually a difference between HMO and PPO plans.
HMOs are a prepaid network plan. They have a network of doctors that you pay into and then when you go to see the doctor your expenses are taken care of because you have been paying into the pool of money that pays the doctors. This generally means that you must have a primary care physician (PCP) as your frontline care manager. If you need to see a specialist you go to your PCP and they refer you to one in the network. You pay full price for any physician out of the HMO network. They have lower premiums and copays usually.
PPOs are pay for service models where you can go see anyone you like. There is a network and it is cheaper to see doctors in network and out of network doctor visits and procedures (outside of emergencies) just cause you to pay a higher percentage than in network. Usually with a PPO you can go straight to a specialist if you like. Your PCP may refer you to a specialist if you have an issue beyond their level of care anyway but if you know you have an orthodpedic problem for example you can go straight to the specialist. Generally PPOs have a higher monthly premium.
Both types of plans generally cover preventative medicine at little to no cost. HMOs lean a bit harder on encouraging preventative maintenance because they want to minimize unnecessary use of medical care, same reason they usually make you get seen by a PCP to get referred to a specialist.
That is a very simplistic overview. There are other types of health insurance and details will vary by plan. But those are the two major types.
Depends on the specialist, many only take people who have been referred. Generally, the more specialized they are the more likely it is that you need a referral to see them.