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[Sticky] Referrals to Specialists


Michael Gray MD JD
Posts: 107
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NO specialist referrals generally must be provided by your primary care doctor who is in your insurance network.

A telehealth provider can evaluate your symptoms and history, determine whether a referral is appropriate, and recommend that you seek a referral from your primary care.  In most cases insurance will not honor a formal written referral from an out of network provider, espeically if you have an HMO.


What telemedicine providers can typically do for referrals

During a virtual visit, a clinician can:

  • Review your medical history and current concerns

  • Determine whether a specialist referral is needed

  • Identify the appropriate specialty (e.g., cardiology, dermatology, neurology, endocrinology)

  • Provide guidance on urgency and next steps

Telemedicine is especially useful for:

  • Non-urgent specialty evaluations

  • Ongoing chronic condition management that needs escalation

  • Second opinions or further diagnostic workup


When an in-person visit may be needed first

You may be asked to be seen in person (or urgently) if:

  • Your symptoms are severe, rapidly worsening, or potentially emergent

  • A physical exam is essential to decide the correct referral

  • The condition might require immediate procedures or imaging

In those cases, urgent care or emergency evaluation may be safer before referral.


Tips to prepare for a telehealth referral visit

Have ready:

  • Your main concern + how long it’s been going on

  • Prior diagnoses or test results

  • Medications and treatments tried


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