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A non-government resource, powered by health insurance experts.
A non-government resource,
powered by health insurance experts.

Q: What Is a Doctor Referral?

Asked by Anonymous on October 11, 2017

Hal Levy October 11, 2017

Some medical care has to be ordered by your primary care doctor. While you can visit a clinic or emergency room without prior authorization, other circumstances will require you to get a doctor’s note before receiving care. This note is called a referral.

How to Get a Doctor’s Referral

To get a doctor referral you’ll generally want to visit your primary care provider – whether they’re a family practitioner, internist, or pediatrician. If you have an injury to a body part, you could also visit a doctor who treats that body part. The doctor will screen your condition and give you a paper referral that you can take to the doctor of your choice that’s covered by insurance.

For instance, you can’t ask for an X-ray on your own. Your insurance policy might also ask you to get a referral before you visit a highly specialized doctor, like a cardiologist.

It’s very common for doctors to approve referrals, and your doctor should be happy to do so.

If Your Insurance Plan Doesn’t Require Referrals

If your plan lets you see a specialist without a doctor referral, that specialist may still need to write a referral for diagnostic tests or additional specialists. For example, a podiatrist (foot doctor) can write you a referral for multiple physical therapist visits. Sometimes getting a referral when you don’t need one will make it more likely that your plan approves your continuing care in the future.

When scheduling a visit with a medical professional for the first time, it’s a good idea to ask if they need a doctor referral from your insurer. You’ll want to make sure that the medical professional you’d like to see can accept you as a patient.

Taking the Next Steps

You can evaluate your health coverage and see if it’s the best option for your needs. Looking to switch to plan that won’t require a doctor referral to see a specialist? Search our database of individual health insurance plans to find the right plan for you.

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