When doctors finish medical school and go into their residencies and fellowships, some choose to specialize and receive additional training in certain fields. For example, some become cardiologists and receive extra years of practice learning about heart conditions and how to treat them. This gives them more in-depth knowledge of the way that these systems work and the way that diseases they can affect them.
A primary care physician, on the other hand, has a much broader knowledge base that allows them to handle most everything that they see in their office. However, sometimes the deeper expertise of a specialist is necessary in order to properly treat a condition that you may have.
When is it the right time to ask your doctor to refer you to a specialist? Below, you'll find three signs that it may be time to ask your primary care doctor for a referral.
1. Your Insurance Requires a Referral for Coverage
Depending on what type of health insurance plan you have, your insurance may not cover specialist appointments that you arrange yourself. Health maintenance organizations (HMOs) rarely cover specialist appointments unless you are referred to their practice by your primary care doctor. Some point-of-service health care plans also require referrals for coverage.
In order to see if your health insurance requires referrals, check your health insurance plan's statement of benefits. If you require referrals and you schedule an appointment with a specialist without one, you'll be expected to pay the full cost of being seen. In order to get coverage, you'll need to visit your doctor and ask him or her for a referral to the specialist that you wish to see.
2. You're Having Trouble Finding the Right Diagnosis
Most primary care doctors are either family medicine physicians, internal medicine physicians, or pediatricians. They're trained to diagnose a very wide variety of medical conditions — after all, they're your first point-of-contact in primary care.
However, you may have a condition that's rare or one that's presenting with unusual signs or symptoms. In this case, it may be extremely difficult to diagnose within a few office visits. If you or your doctor don't seem to be making any headway discovering the true cause of your symptoms, you may wish to ask for a referral. Your physician will know colleagues who may be more familiar with treating it.
3. You Have a Medical Condition That Can Potentially Be Serious
One of the benefits of asking for a referral is that your doctor can send your electronic health records to the specialist's office immediately. This includes all of your lab results, diagnostic imaging, and medical history.
Having all of this information available helps the specialist diagnose your condition more quickly. In addition, your primary care doctor may be able to run additional tests when you ask for a referral, and these results can be quickly sent to the specialist when they arrive.
If you have a medical condition that can potentially be debilitating or life-threatening, expediting your care is important. When your condition can be diagnosed quicker, it means that effective treatment can begin sooner.
Overall, referrals are an important part of making sure that patients are treated to the best of the overall medical system's ability. If you feel that you need to be referred to a specialist for your symptoms, consult with your primary care doctor. He or she can help you determine if a referral is the right approach for you and point you in the direction of a well-respected specialist that can best treat your condition.