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When Primary Care Requires a Specialist

Seeking Referrals from your primary care physician

Although your primary care doctor is the person who knows you and your health best, there are times when he or she cannot give you specialized forms of care. Greater patient volumes and more highly specialized treatments are causing primary care providers to refer more patients out to specialists (see the graphic below). A primary care physician’s training and background is much different from the specialized training of specialty care physicians such as a rheumatologist, cardiologist or an obstetrician. Sometimes, you’ll need to get a referral from your primary care doctor to see a specialist for more specific care.

It’s important to obtain a referral from your primary care physician for a couple of reasons. First, your doctor knows your health the best and can determine if a condition is truly something to be concerned about, or if it can be treated through primary care. Second, many insurance providers will not cover the cost of a specialist unless your doctor refers you to one (although this is beginning to change).

If you’re in need of specialized care, but are unsure of how to go about getting a referral from a primary care doctor, use these four tips to get the care you need:

1. Find a primary care physician who’s associated with a health network

Doctors who are associated with hospitals and/or health networks typically have easy access to a variety of specialists. They can easily share your medical records and files and usually have very open lines of communication to leading specialists in the region.

2. Build a strong and positive relationship with your doctor

A positive relationship will make you more comfortable in asking for a referral, and your doctor will be able to make a referral based on your expectations for appointments. If you’re very thorough and ask a lot of questions, your doctor will be able to recommend a specialist who can accommodate that. 

3. Do your research

Before you make an appointment with your primary care physician to ask for a referral, read up on your insurance provider’s policy on specialized care and referrals. There may be some valuable information you didn’t know about. Also, coming prepared to the appointment allows your physician’s office to get you in front of a specialist more quickly.

4. Be an advocate for yourself

The most certain way to obtain a referral is simply asking for one directly. If you feel as though something is truly wrong with your health, and want a second opinion, there is no harm in asking your doctor, even if he or she thinks it’s unnecessary to see a specialist. Even if the specialist finds that you’re in good health, you will at the very least leave with peace of mind.

Know when to switch

If you feel strongly that you need to see a specialist and get a second opinion, but your primary care physician won’t give you a referral no matter how many times you ask, it might be time to switch doctors. Your primary care physician should be your partner in maintaining your health, if he or she isn’t responsive to your needs, it could be time to find the right doctor for you.

If you’re looking for a physician within a health network that’s connected to specialists and provides access to nearby hospitals, look no further than the CMH physicians. Get to know our doctors by watching our doctor bio videos or using a the Find A Doc tool.

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