Anonymous asked in Business & FinanceInsurance · 10 months ago

Why do so many people act like you have to have a primary care Dr. decide if you should see a specialist?

I chose regular medicare, so I don't have to ask a primary Dr. if I can do anything. Do most people choose a plan where they have to waste time running to their primary Dr. to get permission for everything? I think this is not only dangerous, but it's a waste of time having to run to to two Drs. I honestly don't see how that can save money. Please explain how it does. Regular Drs. cannot do everything.


My medigap does pay for me to go directly to a specialist, they have plenty of times. I don't need a referral. What a waste of time, and it's dangerous if something seriously is wrong because it causes someone to have to wait.

Update 2:

I would think someone should be able to go to a cardiologist right away if they're having chest pains instead of waiting to get a primary care Dr. to say it's OK. This is too serious of a problem to delay.

13 Answers

  • Linda
    Lv 6
    9 months ago

    That's just the way health insurance works when you're employed.

  • zipper
    Lv 6
    9 months ago

    The insurance companies Aguirre it> PERIOD!

  • Anonymous
    9 months ago

    "Why do so many people act like you have to have a primary care Dr. decide if you should see a specialist?"

    Because they are not educated in the Medical Field enough to make such choices for themselves. As, I believe it was Rick, pointed out there is a whole lot of difference in Cardiovascular and a Cardiology event.

    Then there are people such as yourself who know everything and need NO ON to guide you!

  • Flower
    Lv 7
    9 months ago

    The primary care doc can decide if you should see a specialist but not all specialties require a referral.

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  • Shay
    Lv 7
    9 months ago

    You should have a primary care doctor who is familiar with your medical history for the little medical issues that you might need. Not every medical event you have will require a specialist. A primary care doctor is great for things like preventative annual physicals and having someone to go to when you just aren't sure which type of specialist you should see first. Just because you have a primary care doctor doesn't mean you can't skip them and go straight to a specialist if you know which kind of specialist you need to see.

    If you KNOW which kind of specialist you need for the issue you are having, then there is nothing wrong with skipping your regular primary care doctor and going straight to a specialist if that is what your insurance allows. Just because someone has a primary care doctor doesn't mean you HAVE to use them first.

    Some specialists DO require referrals to avoid wasted time with self-diagnosing patients who have picked the wrong kind of specialist for the issue they are having.

  • 9 months ago

    1) Most people think HMOs require referrals which is why most people don't like HMOs. But, in reality many plans do NOT require a referral.

    2) To answer your question, the statistic is that about 80-90% of what's wrong with you CAN be treated by the primary care which is significantly cheaper.

    I'll give you an example of someone I know that had a swallowing issue. Do you go to an ENT or a Gastro? This person didn't have to get a referral so went to a gastro first and ended up getting a swallow study that showed nothing. The next week, they week to the ENT and the ENT was able to diagnose in office. Had the person been required to see a primary first, arguably could have avoided the swallow study which was in excess of $1,000.

    So, in short, using a primary care can save both the consumer time and money and the insurance company money -- which all reflects in the premiums everyone pays and complains about ultimately.


    In no world would somebody be setting up an appointment with a primary or a specialist if they're experiencing chest pains. "Hi, I'm having a heart attack." "Great, how's Tuesday at 2pm?" More than likely skipping the appointment and heading to the emergency room. But, heading to a cardiologist when you're not a doctor for minor issues is probably not the best idea.

  • lucy
    Lv 7
    10 months ago

    IF, you are having chest pains, then you should 1st go to the ER. After an ER visit, then most ER's will suggest you make an appointment with a cardiologist for a follow up appointment.

    No, with straight Medicare, you don't need a referral from your primary doctor, but in most cases, if a (new) patient, then they will want your medical records from your GP (prior) to your visit, thus after, they would forward your records to your GP.

    And with (any) specialists, (new/current) to get an appointment usually is difficult and many times, can take weeks/months to get the appointment.

    I went to the ER in December for kidney stones and was told to have a follow up with a urologist w/in a few days, but my 1st appointment was not for almost 3 weeks to get in.

    Now, what if your complaints are not what you think they are, thus do like most of us and google them, only to find out that what you suspect is not what is wrong with you. Now with many GP's, can get into their offices if needed w/in a day or 2, and after the GP examines you and if they (believe) you need a specialist, then most offices will schedule you while there at the office and usually will save time.

  • 10 months ago

    It saves because you do not go to the specialist as often. The specialist costs more than the primary care doctor.

  • 10 months ago

    It's up to the insurance company. Most people have limited options since most companies only have one or two options to choose from. I do think it saves money though.. If given the option a lot of people would run to an ear nose & throat specialist for a common cold, instead of just their PCP..

  • Mark
    Lv 7
    10 months ago

    I have no idea. The insurance plan *I* have specifically states that for most conditions, you don't HAVE to go to your G.P. first. Still, unless it is quite obvious what your ailment is, it's probably a good choice to go to your G.P. first. For instance, once I though I needed to have back surgery, and I just happened to already have an appointment with my G.P., and she said "your back is hurting because your wallet is too fat. You're always sitting lopsided." Guess what? She was right! (In other words, I saved myself time, because I overlooked something exremely easy to take care of myself.)

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