Understanding your Specialist referral options

Written by Navy Health and HealthShare

You or a loved one have visited your trusted GP and have been referred to a Specialist, or maybe you have an upcoming GP appointment where you anticipate being referred. It can be an anxious time.

When making a referral, your GP will always have well considered reasons for recommending the selected Specialist. However, as an individual, there are various personal and often competing factors that are important, contributing to your sense of comfort and security. You may wish to avoid an anxious wait for the first specialist appointment and therefore prioritise immediate availability, where for others, convenience of location, cost, or a personal recommendation from a trusted friend or family member might be more important to you.

Most people don’t realise it, but should you prefer to take your referral to a specialist of your choice, you have that right. Here’s a quick look at how to choose your own specialist, should you wish to.

1. Request an open referral from your GP

The Department of Human Services set the guidelines for specialist referrals. Your GP must include relevant information about the reason for referral, date of referral and their signature, however, the Department of Human Services states that “Referrals don’t need to be made out to a specific specialist or consultant physician”.

This is known as an ‘open referral’ which you may request from your GP, and it means that your referral can be presented to any specialist you choose, as long as they’re in the referred speciality field.

2. Taking a named specialist referral to a different specialist of your choice

This choice also extends to named referrals. According to The Department of Human Services, “Referrers should let patients choose where to present the referral”. You may accept the specialist referred to by your GP, however, you are entitled to present the named specialist referral to another specialist of your choice at any time within 12 months – so long as you have not attended an initial consultation with another specialist under that referral and your chosen specialist is within the same specialty as that on the named specialist referral.

In this case, it’s a good idea to call ahead and speak to the receptionist, Practice Manager or Specialist. Just let them know that your referral is for another specialist, but you are entitled to make an appointment with them and that is your wish. There is no need to get a new referral from your GP, and while you may wish to advise your GP, it is not necessary to do so.

Getting the most from your referral

Here are some tips for finding the right Specialist for you:

1. Have a conversation with your GP
By understanding the reasons for their referral choice, you may decide to go with their suggestion after all. Most doctors are open to discussing this, as they ultimately want to meet your needs and see that you receive the best treatment possible.

2. Search the Navy Health Find-a-Provider tool, powered by HealthShare
Once you know the specialty, search by location and other factors that are most important to you. A couple of useful things to look at are:

• Health insurer gap scheme participation – this will give you a guide of possible out of pocket costs and gap scheme participation frequency, based on recent member claims visible to the health fund for each specialist.
• Ability to take urgent appointments – this is a good indicator of Specialists who may be able to see you sooner.
• Other Profile information – sub-specialties, special interests, languages spoken or other factors which may be important for you.

You can find this information at navyhealth.com.au/providers/find-a-specialist

Talking to your healthcare practitioners
Understanding your Specialist referral options, discussing with your GP and accessing the Navy Health provider search tool can enable better informed health choices. To make sure you find the appropriate specialist for you, it’s worth having some conversations around your needs and expectations. Is urgency a big consideration? Would you wait longer to see a Specialist that a friend has seen before? Does your GP know of someone you can call to speak with?
Being aware of your options is the best way to have productive discussions with your healthcare providers. For more information on health and wellness, you can explore over 84,000 healthcare professionals and 370+ health topics, on www.healthshare.com.au.

References
1. 2018 HealthShare survey 1503 respondent
2. Department of Human Services > Referring and requesting Medicare services, 26 September 2018
https://www.humanservices.gov.au/organisations/health-professionals/subjects/referring-and-requesting-medicare-services#a2