Will You Need a Referral on Medicare?

[@davidfolts5893]

65.2k subscribers speak to the quality of content Danielle Roberts provides and to her excellent business, Boomer Benefits.

[@BoomerBenefits]

thanks david!

[@g0989]

It's worth noting that some specialists out there will only accept patients referred by a PCP or other provider, regardless of what kind of insurance the patients has, (yes, even with original Medicare). It's just the way they operate their practice.

[@cheyenne5963]

I disagree I have original Medicare and tie in insurance to cover all expenses that Medicare does not cover. I can pick choose whom and whatever I want specialist anywhere in America even the Mayo Clinic without any referral. If your claiming some doctors and specialists won’t accept original Medicare with tie in insurance apparently these doctors might not be good physicians.

[@g0989]

@@cheyenne5963 What I'm saying is that some specialists will only accept patients on a referral basis, even if they accept original Medicare, and the patient has original Medicare. I suppose it is a way to sort of screen out patients beforehand that they feel could be properly treated by a PCP or other type of specialty, and allows them to dedicate their time and skills on patients they feel they are best able to treat.. Even with original Medicare, it is at a provider's discretion as to whether they will accept that person as a patient at all. My understanding is that nationally-renowned specialty treatment centers (like Mayo Clinic, for example), can be tough to get into without a physician referral, as prospective patients from across the nation seek admission to these facilities. They simply can't accept everyone who applies.

[@woofwoof-w4g]

@@cheyenne5963 Cheyenne, you missed their point. Here it is: I just tried with my work insurance to get an appt with a specialist. Neither my insurance, nor yours, is the issue. Some Specialists simply want their referral to them to be by your PCP, so my PCP gave him the go-ahead, he couldn't just hear it from me.

[@D__Lee]

@@mbaker260I have ORIGINAL Medicare. Last year, I wanted to see a Sports Medicine specialist so I called the clinic. The scheduler said that they require a referral from my PCP. I told the scheduler that I had ORIGINAL Medicare and NO referral was necessary. The scheduler was still adamant that a referral was required. I think the scheduler worked remotely from home so I hung up and called back again. I got a different scheduler who scheduled an appointment without any referral.

[@g0989]

@@cheyenne5963 I'm saying some specialists who accept Medicare assignment may require a referral REGARDLESS of what kind of insurance the patient has, including original Medicare. This presumably allows these specialists to concentrate on those patients who they feel would be the best candidates for that particular provider's area of expertise, as they would have already been screened by their PCP or other provider. There is no requirement for any provider to accept a patient, (unless an emergency), even if they accept that patient's insurance. Generally speaking, the only insurance requirement for a specialist referral, will be an HMO plan, be it Medicare Advantage, or non-Medicare commercial insurance. PPO plans do not require referrals, from an insurance standpoint.

[@janetwaters7956]

Do i need a referral to see a specialist for Medicare B? Do a need a referral to see a specialist under my AARP United Healthcare Medicare Supplement?

[@BoomerBenefits]

Typically Medigap plans do not require a referral but your specific specialist might require one. Its best to ask the office!

[@mbs5328]

When is a referral needed in Original Medicare?

[@g0989]

Rule of thumb is that generally only HMO insurance plans require a referral to see a specialist, and this applies to both Medicare Advantage HMOs as well as non-Medicare commercial insurance HMO plans. PPO plans don't require referrals, nor does original Medicare, or original Medicare paired with a Supplement.

[@BoomerBenefits]

Original Medicare may not require a referral, but some providers do require it, no matter your insurance!

[@janetwaters7956]

​. Is this answer referring to Medicare Advantage plans