Is a referral better than a cold call? How do they work?
May 11, 2013 1:12 PM Subscribe
My insurance doesn't require referrals to specialists. I've never seen a specialist for a specific problem that wasn't initiated and referred by my doctor. If I want/need to see a specialist for something, does it make sense to see my doctor first and ask for a referral, or find a (random) specialist myself? On the other side, when does a doctor not give referrals?
Up until now, I've always been referred to surgeons and radiologist and other "procedural" specialists for specific issues recognized by my nephrologist. Until this week, I hadn't had a separate Primary Care Provider since I was a child. My insurance doesn't require me to have one (though encourages it), and I hadn't had general issues important enough to bother with getting one.
Recently I talked with a social worker about issues I've been having with depression and anxiety. She recommended I find a PCP and bring it to him/her in order to get referred to a psychiatrist and/or therapist. She wasn't able to get a referral for me to any specific GP, but gave me a (vague, eventually useless) list of doctors to try. After a couple of false starts, I eventually managed to get an appointment with a doctor who is now my PCP.
When I saw him at the introductory appointment, he said he didn't refer patients (or wouldn't refer me specifically? I'm not sure) for psychiatric issues, and I'd have to find my own. So I'm back to square one with that.
It makes me wonder, more generally, when you don't strictly need a referral for your insurance, does it always make sense to see your PCP first anyway, for a referral or a recommendation? When and why do doctors sometimes refuse to make referrals? Is it because the issue is too general ("depression and anxiety" vs. "consult for angiogram")?
When is it not appropriate or unexpected to call your PCP's office and ask for a referral to see a specialist, when they'll just tell you to find one yourself and make an appointment?
Up until now, I've always been referred to surgeons and radiologist and other "procedural" specialists for specific issues recognized by my nephrologist. Until this week, I hadn't had a separate Primary Care Provider since I was a child. My insurance doesn't require me to have one (though encourages it), and I hadn't had general issues important enough to bother with getting one.
Recently I talked with a social worker about issues I've been having with depression and anxiety. She recommended I find a PCP and bring it to him/her in order to get referred to a psychiatrist and/or therapist. She wasn't able to get a referral for me to any specific GP, but gave me a (vague, eventually useless) list of doctors to try. After a couple of false starts, I eventually managed to get an appointment with a doctor who is now my PCP.
When I saw him at the introductory appointment, he said he didn't refer patients (or wouldn't refer me specifically? I'm not sure) for psychiatric issues, and I'd have to find my own. So I'm back to square one with that.
It makes me wonder, more generally, when you don't strictly need a referral for your insurance, does it always make sense to see your PCP first anyway, for a referral or a recommendation? When and why do doctors sometimes refuse to make referrals? Is it because the issue is too general ("depression and anxiety" vs. "consult for angiogram")?
When is it not appropriate or unexpected to call your PCP's office and ask for a referral to see a specialist, when they'll just tell you to find one yourself and make an appointment?
It makes me wonder, more generally, when you don't strictly need a referral for your insurance, does it always make sense to see your PCP first anyway, for a referral or a recommendation?
Pretty much, but that assumes some level of familiarity with your PCP.
When and why do doctors sometimes refuse to make referrals? Is it because the issue is too general ("depression and anxiety" vs. "consult for angiogram")?
There are several reasons I can think of off the top of my head, from his perspective: he may not know any good psychiatrists who aren't already booked up; he may not realize that your issues aren't temporary (one of the self-reinforcing problems with mental-health issues is that they often make people with them less good at communicating their severity (viz. the recent Hyperbole and a Half discussions)); you might be a drug addict in search of a fix (I am emphatically not accusing you of this, I'm just saying that it's a concern that a physician may have on someone's first visit).
When is it not appropriate or unexpected to call your PCP's office and ask for a referral to see a specialist, when they'll just tell you to find one yourself and make an appointment?
Once you've established a better relationship with this PCP (or some other one), it'll be in your best interest to call just so it's in his or her mental file (or that of the PA or nurse). Also, your PCP may be able to get you bumped up the list because he has a relationship with a particular specialist.
posted by Etrigan at 1:24 PM on May 11, 2013
Pretty much, but that assumes some level of familiarity with your PCP.
When and why do doctors sometimes refuse to make referrals? Is it because the issue is too general ("depression and anxiety" vs. "consult for angiogram")?
There are several reasons I can think of off the top of my head, from his perspective: he may not know any good psychiatrists who aren't already booked up; he may not realize that your issues aren't temporary (one of the self-reinforcing problems with mental-health issues is that they often make people with them less good at communicating their severity (viz. the recent Hyperbole and a Half discussions)); you might be a drug addict in search of a fix (I am emphatically not accusing you of this, I'm just saying that it's a concern that a physician may have on someone's first visit).
When is it not appropriate or unexpected to call your PCP's office and ask for a referral to see a specialist, when they'll just tell you to find one yourself and make an appointment?
Once you've established a better relationship with this PCP (or some other one), it'll be in your best interest to call just so it's in his or her mental file (or that of the PA or nurse). Also, your PCP may be able to get you bumped up the list because he has a relationship with a particular specialist.
posted by Etrigan at 1:24 PM on May 11, 2013
Maybe you're getting hung up on the word referral, which I believe is more of a technical term for the process that patients have to go through to gain access to a specialist when their insurance requires them to start by seeing a PCP (often in the hopes that the cheaper PCP will be able to solve the medical issue). You may want to ask your doctor for a recommendation instead since that's really what you're looking for. Doctors may say they "don't do referrals" because they don't take insurance that requires referrals, for example.
In any case, I have always gone and found my own specialists rather than starting with my PCP if I knew he wasn't really going to be able to help me with the problem I was having. It's more convenient and then I can do independent research and not just take whomever my PCP knows through networking or who works in the same building or whatever.
posted by joan_holloway at 2:14 PM on May 11, 2013 [2 favorites]
In any case, I have always gone and found my own specialists rather than starting with my PCP if I knew he wasn't really going to be able to help me with the problem I was having. It's more convenient and then I can do independent research and not just take whomever my PCP knows through networking or who works in the same building or whatever.
posted by joan_holloway at 2:14 PM on May 11, 2013 [2 favorites]
Some mental health providers prefer that patients come in of their own volition, so that may be playing into your PCP's policy.
I've heard several MDs surprised when mental health care providers require that the patient initiate the referral, so I suspect that referrals are the norm for most other medical specialties. (They can sometimes be a pain for the referring doctor's office staff, though, so if the staff is being wishy-washy about it, they may just be trying to get out of the work of copying and faxing your files.)
posted by jaguar at 2:33 PM on May 11, 2013
I've heard several MDs surprised when mental health care providers require that the patient initiate the referral, so I suspect that referrals are the norm for most other medical specialties. (They can sometimes be a pain for the referring doctor's office staff, though, so if the staff is being wishy-washy about it, they may just be trying to get out of the work of copying and faxing your files.)
posted by jaguar at 2:33 PM on May 11, 2013
I grew up with insurance that required a referral- you could not see a psychatrist or derm or podiatrist without your PCP "agreeing" that it was severe enough of an issue to warrant a specialist, and they would send you to a specific person they knew, not just a random. My insurance now is totally different; my doctor will refer me to a type of specialist if needed, but it's more of a "your insurance has an allergy department, and you need to see an allergist, so go see the first available one today" than a referral to a specific doc. i have also taken myself to a psychiatrist, opthalmologist and dermatologist just because i thought i needed it. It is really just as simple as calling your insurance company to get a list of specialists that are included in your plan, then picking one and making an appointment. I usuallyaskfriends for recommendations, look for reviews online, and look at the doctor's state registration and legal actions to help me pick, but you don't have to, obviously.
I think the social worker is only familiar with the first type of insurance and is giving you incorrect advice on the process. However i would also think that a social worker with a MSW is probably well- versed in psychology and I'd consider his/her advice to be a decent enough "referral" to suggest you might seek out a therapist.
posted by holyrood at 3:49 PM on May 11, 2013
I think the social worker is only familiar with the first type of insurance and is giving you incorrect advice on the process. However i would also think that a social worker with a MSW is probably well- versed in psychology and I'd consider his/her advice to be a decent enough "referral" to suggest you might seek out a therapist.
posted by holyrood at 3:49 PM on May 11, 2013
It is HMOs and PPOs that typically require a PCP referral. It's inherent in the concept of "managed care," with the PCP acting as the gatekeeper to ensure that a specialist will be consulted only if needed.
posted by yclipse at 4:42 PM on May 11, 2013
posted by yclipse at 4:42 PM on May 11, 2013
It's possible that your PCP would just treat your depression with an antidepressant and let it go at that - that's what mine did. PCPs prescribe antidepressants all the time. I note that your regular doctor is a nephrologist, though - have you mentioned your depression to him? You probably should - who knows? Maybe it's a side effect of a medication you're on or connected in some way to your physical condition.
posted by aryma at 8:46 PM on May 11, 2013
posted by aryma at 8:46 PM on May 11, 2013
If you have no clue as to a specialist you want to see, then it's a good idea to call your PCP (or PCP's office) for a recommendation. At worst, they'll not be able to help (no recommendation, or not help recommendation[s]); then you've just spent a little extra time. But it doesn't make sense to me to try to actually see your PCP (schedule a doctor's visit) if all you want is a recommendation. (That's in general; in this case, you might want an office visit to discuss whether any of the medications you're taking might have side effects of anxiety or depression.)
There are places on the Internet where you can find reviews of physicians. I happen to like Angie's List (which covers a huge variety of service providers, not just physicians), but that's not free. A free alternative is ZocDoc, which not only has reviews but also automates the processes of finding a doctor who takes your insurance and of scheduling an appointment.
In general, regarding anxiety and depression, there are alternatives to psychiatrists. Someone who offers cognitive behavioral therapy, for example, may be a psychologist and not an MD. If you can find someone to help you manage your emotions without using drugs, that's definitely a good thing.
One last bit of advice: if you go the route of therapy rather than drugs (or therapy combined with drugs), don't continue with someone that you feel is not helping you improve (much). It's perfectly fine to do one, two, or three sessions with a therapist, and decide that you want to try someone else, or even a completely different type of therapy. Effective therapy should make a difference within a matter of a couple of months, at most.
posted by WestCoaster at 11:13 AM on May 12, 2013
There are places on the Internet where you can find reviews of physicians. I happen to like Angie's List (which covers a huge variety of service providers, not just physicians), but that's not free. A free alternative is ZocDoc, which not only has reviews but also automates the processes of finding a doctor who takes your insurance and of scheduling an appointment.
In general, regarding anxiety and depression, there are alternatives to psychiatrists. Someone who offers cognitive behavioral therapy, for example, may be a psychologist and not an MD. If you can find someone to help you manage your emotions without using drugs, that's definitely a good thing.
One last bit of advice: if you go the route of therapy rather than drugs (or therapy combined with drugs), don't continue with someone that you feel is not helping you improve (much). It's perfectly fine to do one, two, or three sessions with a therapist, and decide that you want to try someone else, or even a completely different type of therapy. Effective therapy should make a difference within a matter of a couple of months, at most.
posted by WestCoaster at 11:13 AM on May 12, 2013
This thread is closed to new comments.
If your insurance doesn't require referral, I'd only see your PCP for things that you couldn't figure out for yourself - that is, if you have a skin lesion, you may want to skip right to the dermatologist. If you've got a cough that won't go away, the PCP's probably the one to see first.
posted by Mooski at 1:18 PM on May 11, 2013 [1 favorite]