Why can't I see a specialist without a referral?
Asked by: Dr. Geovanni Cremin | Last update: August 20, 2025Score: 4.2/5 (26 votes)
Can you see a specialist without a referral?
What if I don't get a referral? There's nothing to stop you from seeing a specialist without a referral, but the problem is that you will be responsible for the full cost of the visit. The insurance company will not cover it. So instead of paying a copay, you'll be stuck with a much higher bill.
Can you self refer to a specialist?
Generally, you cannot self-refer to a specialist at a hospital within the NHS, except when accessing sexual health clinics or A&E treatment. A specialist will only see you with a letter of referral from your GP.
Why won't my doctor refer me to a specialist?
Perhaps it's because your doctor thinks he/she adequately understands your symptoms and doesn't believe there is cause for concern. Or, maybe you require a procedure he/she thinks can be sufficiently managed by your primary care practice.
What happens if I don't have a referral?
If you do not have a referral from your primary care physician, your HMO likely will not cover the service. Some modern HMOs have relaxed these rules and allow members to visit specialists within the plan's network without having a referral from their primary care physician.
Why do I need a referral to see a specialist?
Why is it so hard to get an appointment with a specialist?
There are a number of reasons getting an appointment with a specialist can be difficult: High demand: Specialists are highly sought-after by patients in need of complex care. They have a limited number of time slots available in the day, and many may also be away from their office multiple times a week.
Why would a doctor not give a referral?
Some doctors view a request for a second opinion as a loss of faith in their ability to diagnose and care for you. And, in the high-pressure world of medical care, it may be difficult for your physician to set their ego aside and admit they may have been mistaken in their initial diagnosis.
How to see a specialist quickly?
- Put your name on a waiting list. ...
- Be ready to act fast. ...
- See someone else in the practice. ...
- Use your doctor's network. ...
- Get video care on demand. ...
- Try a convenient care clinic. ...
- Lean on your primary. ...
- Ask about an e-consult.
Should I go directly to a specialist?
If you already have a specialist who is treating you for a problem related to their specialty, start with your specialist. But if you don't currently have a specialist, your first stop should be with your primary care physician, who has been trained to diagnose complex conditions.
Can you sue a doctor for not referring you to a specialist?
Doctors are legally bound to refer their patients to specialists if they can not provide the patient with the necessary care or knowledge to assist them. If you have been directly harmed as a result of your doctor's failure to refer, you may qualify for financial compensation in a medical malpractice lawsuit.
How do you get your doctor to give you a referral?
- Visit Your Primary Care Physician. Your primary care physician will evaluate your concern and, if necessary, make a referral to a specialist. ...
- Verify Your Insurance and Referral Information. Contact your insurance company for referral requirements. ...
- Make an Appointment with the Specialist.
Can I refer a patient to myself?
The Physician Self-Referral Law (aka, the “Stark Law”)
The Physician Self-Referral Law is actually a set of laws that make it illegal for physicians to refer patients to themselves.
Can any doctor write me a referral?
Most referral letters are written by your family doctor (general practitioner, or GP). Referrals can be made to: a specialist doctor. an allied health professional, such as a psychologist or physiotherapist.
Which type of insurance does not need a referral to see a specialist?
Exclusive Provider Organization (EPOs)
Most of the time, you do not need to get referrals to see specialists who are in-network. EPOs can have many limits on the doctors or hospitals you can use. With an EPO, you can use the doctors and hospitals within the EPO's network.
Can you ask your doctor to refer you to a specialist?
If the reviews are bad or if the wait for an appointment is too long, you can always go back to your doctor and ask for someone else. You're the patient, so your needs are most important. If anything you find out later makes you uncomfortable, you can always ask for a referral to a different specialist.
Can I see an orthopedic without a referral?
Most patients have the option to visit an orthopedic doctor without a referral. But check with your insurance provider to see if a referral is necessary to access the payment coverage that you need.
Why can't you see a specialist without a referral?
Insurance companies make referrals to prevent patients from seeing a specialist for a problem that a GP can solve. They realize that an unnecessary visit to a specialist would cost themselves and the patient extra time and money.
Does a doctor have to refer you to a specialist?
Unless you can self-refer, specialists will only see people with a letter of referral from their GP or a hospital doctor.
Can a specialist refuse to see you?
Many people believe they have a right to health care in the United States. In reality, the laws only obligate physicians to treat patients under certain circumstances. A physician can, in many cases, legally refuse to treat you and refer you to a different practice.
Why is it so hard to see a doctor now?
The U.S. is facing a physician shortage, in primary care and many specialties, which can lead to longer wait times for patients and reduced access to care. Learn more about this current physician shortage and how the AMA is helping to address it.
What is the process of seeing a specialist?
Accessing a specialist
If your doctor thinks you should see a specialist, they will write you a referral letter, which needs to be presented to the specialist either before or at your first appointment.
What is the easiest specialist?
- Family Medicine.
- Internal Medicine.
- Preliminary Surgery.
- Orthopedic Surgery.
- Physical Medicine & Rehabilitation.
- Child Neurology.
How do I get a referral if I don't have a doctor?
If you don't have a primary doctor or your doctor won't provide a referral, there are alternative ways to obtain one: Urgent Care Centers: Urgent care centers are an option for obtaining referrals for non-emergency conditions. They can evaluate your health issue and provide referrals to specialists if needed.
Why is my GP refusing to refer me?
What to do if your GP refuses your request. If your GP questions or refuses your request, this could be for several reasons, including the following: They haven't heard of the NHS Right to Choose scheme. They have concerns about funding.
What can I do if my doctor refuses to treat me?
If you are an existing patient who would suffer adverse health effects without continued treatment, your doctor is legally required to provide treatment until you can locate a new doctor. You may have grounds for a medical malpractice case if your condition deteriorates because your doctor refused to provide care.