Why are specialist referrals important?
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When choosing a specialist, it is important you have all the facts. These can include treatment options, potential costs and specialist waiting times. |
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Treatment Options The treatment options you and your doctor would like to explore may influence which and what type of specialist you choose. |
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Specialist fees Specialist fees can vary from doctor to doctor, and may not be easy to determine until you have that initial consultation with your medical specialist. |
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The hidden waitlist A specialist referral is often made without any idea of how long you are going to have to wait, especially if your condition is not urgent. |
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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
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for the name(s) of a recommended specialist |
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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 |
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for referral letter(s) to recommended specialist(s) |
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about the timeframe for consultation period (e.g., 6, 12, 18 months or indefinite) |
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about any fees you may have to pay when you see a specialist |
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Ask your specialist
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about your treatment options |
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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 |
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for referral letter(s) to recommended specialist(s) if you would like a second opinion |
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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 |
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about when you need your next appointment |
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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?
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Out of hospital No health insurer in Australia can cover this as set out in the Health Insurance Act 1973. |
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In hospital It depends on your policy and level of cover. Understanding your cover |
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How much is my hospital procedure likely to cost? Try our hospital procedure calculator |
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What do I need to know about what is written on my referral letter?
Knowledge is power
Your GP can provide your specialist(s) with the right background information about your health condition and updates. This helps them better understand
your needs and coordinate your treatment plan. Keeping the lines of communication open is especially important if you have multiple specialist(s) treating you with your GP.
1. Your referral letter does not have to be addressed to a named specialist
The letter could be addressed to a named specialist or to a specialist type. (e.g. "Dear Cardiologist"). This gives you the flexibility to investigate which specialist might suit you best, without having to keep going back to your referring doctor.
2. How long your referral letter stays valid depends on who wrote it
From your GP: your referral will be valid 12 months UNLESS your GP indicates a different time period (such as 3, 6, 18 or indefinite).
From your specialist: your referral letter to another specialist will only be valid for 3 months.
3. The clock starts ticking on the date of your first consultation, not the date on the letter
Your referral letter expiry date is calculated from the date of your first consultation with the specialist. This means you can continue seeing your specialist (for the same condition), for 12 months from the date of your first specialist appointment. After this, you would require a new referral letter from your GP.
4. It is against the law for a GP or referring doctor to backdate a referral
The doctor issuing the referral may face charges and penalties.
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Tips |
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One letter, one specialist, one course of treatment
You cannot use the same referral letter you have already used to attend an appointment with another specialist. You will need to ask for a new referral letter if you would like to see a different specialist.
4 reasons why your specialist will ask you for a new referral letter
- Your original letter has expired AND you need ongoing treatment.
- Your specialist decides your condition needs to be reviewed by the referring doctor to see if you need an ongoing referral.
- You last saw your specialist more than 9 months ago.
- You develop a new or unrelated medical condition.
Keep the receipt from your referring doctor's visit in case you lose your letter.
Medicare will still reimburse you for your first specialist consultation if you can provide a receipt that shows the name of your referring doctor, practice address, provider number and the words "lost referral".