What Is a Referral?

A referral is formal authorization provided by your primary care doctor or healthcare provider allowing you to see a specialist or receive certain medical services. Health plans like HMOs and some Medicare Advantage (Part C) plans typically require referrals for specialist visits, while Original Medicare and PPOs usually do not.

Why referrals matter

• Insurance coverage: Without the required referral, your insurance plan might refuse to cover specialist visits or specific procedures, increasing your out-of-pocket costs.
• Coordinated healthcare: Referrals help your primary care doctor maintain oversight of your care, leading to better communication and fewer duplicated tests or treatments.
• Better specialist access: Proper referrals facilitate smoother, more efficient visits with specialists, reducing confusion and administrative issues.

How Solace can help

A Solace advocate can help you secure necessary referrals, confirm specialist eligibility under your insurance plan, and guide you through the referral process to avoid unexpected expenses or denied coverage. They can also communicate directly with healthcare providers to ensure you receive timely access to specialized care.

What to do next

Have questions about referrals or need help coordinating your specialist care? A Solace advocate can clarify the process and ensure smooth access to the specialists you need. Find an advocate today.