General Question

hug_of_war's avatar

How do you see a specialist (doctor)?

Asked by hug_of_war (10735points) July 27th, 2015

I’ll have health insurance again soon, through my university. Yay! But I need to see an ophthalmologist for my special, special eyes. Do I go to an appointment with a normal doctor and say I need an eye checkup? I’ve been seeing neuro-ophthamologists since I was 4 months old but I’ve never had to figure this out myself. I need a referral for disability services and the agency won’t work with me until I have an updated eye exam, and I really need services. Tell me how this works.

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9 Answers

chyna's avatar

I made my own appointment with an ophthalmologist. I did not need a referral.
If where you live is anything like where I live, you should go ahead and get an appointment now. It takes me 3 to 4 months to get an appointment to see my doctor.

Adirondackwannabe's avatar

In my plan my primary care physician refers me to the specialists. She’s very aggressive on getting me the other doctors. I like her a lot.

DrasticDreamer's avatar

My primary also refers me to specialists when and if I need to see one. Without a referral, it would be far too expensive for me to make my own appointment because my insurance wouldn’t cover the visit. What you can do, if you don’t want to go to your doctor first, is call places that have opthamologists, tell them what your insurance is, and ask if they accept it. If they say “no”, it means your primary doctor needs to refer you before you’ll be covered.

Pachy's avatar

Just like @Adirondackwannabe, I get my referrals through my primary care physician. He sends me only to specialists he knows will accept my health insurance. I’ve been very pleased with the specialists he’s referred me to.

srmorgan's avatar

Check with the university where you will be getting coverage.
They will have a list of physicians who are “in-network” on your new plan.
They will be the best source for you to find out if you can make an appointment by yourself or if you are going to need a referral from a primary care doctor.
As @chyna said, do this as soon as you can because you might have to wait in order to get an appointment. You can make an appointment even if your coverage is not in place,

SRM

gorillapaws's avatar

I just wanted to add that the referral is the patient’s responsibility to obtain. Your primary care should help you out, but you need to be the one to make sure the specialist receives it. In some cases, insurers (scum of the Earth) can drag their feet on processing the referral (because they know x percent will screw up the paperwork and they won’t have to pay—but you will, or your MD will have to eat the cost if you can’t pay), so be sure to start the process early.

Cupcake's avatar

Many insurances are doing away with the referral requirements. Please call your insurance company to find out if you need a referral/pre-authorization to see an ophthalmologist. While you’re on the phone with them, get a list of ophthalmologists that are on your insurance panel.

You’ll probably need the insurance to be active before you make an appointment, but you can call the ophthalmologist to check. Many require your insurance info when you make the initial appointment, so that they can check your coverage.

snowberry's avatar

And just to be certain, be sure to double check to make sure your ophthalmologist is still accepting your insurance on the day of your appointment, and before you see them. Once, between the time that I had set the appointment and the day of the appointment my specialist stopped carrying my insurance. You can’t be too careful!

hug_of_war's avatar

Really helpful info guys!

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