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Why are specialist referrals important?

OSHCstudents – Your GP or specialist will provide you with a referral if your condition needs specialist care that your referring doctor can’t provide.

Why do I need a referral to see a specialist and who will give me the referral?

Your GP or specialist will provide you with a referral if your condition needs specialist care that your referring doctor can’t provide.

Some specialists may be willing to see you without a referral letter, but it’s a good idea to see your GP first, as they are generally in the best position to decide on the kind of specialist you most need. Also, if you see a specialist without a referral, Medicare will not cover any of the costs and your specialist may be missing some details about your health that normally come from a referring doctor.

Before you leave your doctor with a referral letter, you might want to:

Ask your GP
for the name(s) of a recommended specialist
about specialist options in either a public hospital clinic or a specialist private consultation room, as the pathway you choose may impact your wait times and potential out-of-pocket costs
for referral letter(s) to recommended specialist(s)
about the timeframe for consultation period (e.g., 6, 12, 18 months or indefinite)
about any fees you may have to pay when you see a specialist

Ask your specialist
about your treatment options
about specialist options in either a public hospital clinic or a specialist private consultation room, as the pathway you choose may impact on your wait times and potential out of pocket costs
for referral letter(s) to recommended specialist(s) if you would like a second opinion
about any fees you may have to pay. Download the Australian Medical Association’s Informed Consent Form to take with you to your next appointment
about when you need your next appointment

How do referrals affect what I pay?

When you are eligible for Medicare and have a referral, Medicare will reimburse you for a portion of your specialist consultations and treatments.

When you are eligible for Medicare and don’t have a referral, you’ll pay in full for all specialist consultations and treatments.

Does my health insurance cover specialist fees?

Out of hospital
No health insurer in Australia can cover this as set out in the Health Insurance Act 1973.

In hospital
It depends on your policy and level of cover.

OSHCstudents (source: Bupa)

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