Specialist Referrals And When You Might Need One

It is common for health care plans to need a referral from their medical professional to see a specialist. While many of us have familiarity with this procedure, we’re not sure how to initiate it. The process itself isn’t complicated, but it’s essential to know when to start it. The basic answer to “when should I ask for a referral“ is “when you need one.” In most cases, you won’t receive any friction from your dental provider about it, and most expect you to ask when needed.

FAQ About Specialist Referrals And When You Might Need One

The first thing to know about getting a referral is whether your medical insurance plan even needs one. Even if your plan doesn’t require a referral, you still want to ask questions about the provider. There’s nothing worse than going to see an out-of-network provider all unknowing and then getting the bill. While some plans cover out-of-network providers, you’ll need to get approval from your insurance company first. 

A quick way to determine if you need a referral is to know what kind of plan you have:

  • Preferred Provider Organization (PPO) – This plan doesn’t usually require referrals from your provider.
  • Exclusive Provider Organization (EPO) – These plans also don’t require referrals in most cases.
  • Health Maintenance Organization (HMO) – This type of insurance plan almost always requires a referral, even to an in-network provider.
  • Point Of Service (POS) – This form of plan typically requires referrals as well.

Each of these plans has its peculiarities, and no two individual plans are the same within them. The only real way to know when and if referrals are required is to speak to your insurance provider directly. You may also be able to check your member’s handbook to determine when referrals are required.

Other Moments When A Referral Might Be Required Or Preferred

Sometimes you may want a referral even if your health care plan doesn’t require one. This option is typically the best choice when you have no experience with specialists in the field you require. Your provider can give you advice on who to see. This insight is often based on their experience with the specialist. They will also take into account the experiences their other patients have had. 

Other reasons they may suggest a particular specialist include:

  • Financial Need – Some specialists provide sliding scale programs for those in need
  • Holistic Choices – You may prefer a holistic approach rather than traditional medicine
  • Lifestyle Considerations – If you’re LGBTQ, Polyamorous, or part of another non-traditional lifestyle, you may want a specialist who is familiar with your concerns.

These are just some of the moments when you may find yourself looking for specific referrals from your dental provider. There’s some comfort in knowing that they are directing you based on their experience with the provider. Their referral can be the best way to find a new specialist to address your concerns and provide a great experience. If you’re searching for a referral to a specialist, your dental provider can be the best place to start your search.

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Dr. Tatiana was born and grew up in former Soviet Republic of Moldavia.
She was educated and trained as a Dentist at Kishinev State Medical University in Kishinev, Moldova. She provided dental care in Kishinev for many years until she met her future husband. She moved to Cheyenne in 1995.

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