[Sticky] Referrals to Specialists

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