The specialist referral process explained

Accessing a specialist doctor in Australia is more straightforward than you might think. But it’s important to be prepared and understand your options.

Specialist doctors are medical practitioners who are experienced in a specific field of medicine, such as cardiology, psychiatry or gastroenterology. Typically, when you have an issue that needs specialty care, your GP will provide you with a written referral to that specialist.

According to Bupa Medical Advisor and GP Dr Chelsie McMullin, this referral has 2 main purposes.

“Number one is the actual medical handover,” she says. “It’s pointing you in the right direction to get the treatment you need.”

“Then, from a Medicare perspective, you need a valid referral from a GP to be able to get your rebate.”

Medicare is the only form of rebate for specialist consultations. Legally, private health insurance can only cover in-hospital procedures, and the amount covered will depend on your policy.

While some specialists will see you without a referral, many won’t. Moreover, you would pay entirely out of pocket without a referral, as you wouldn’t be eligible for a rebate.

Dr McMullin believes that, regardless, you should always see your GP first. This is because they’re generally the best person to tell you which type of specialist is right.

“Someone might have chest pain, for example, and think they need to see a cardiologist,” she says. “But there are so many different things that can cause chest pain, from anxiety to a chest infection.”

Referrals need to be named with a specific specialist, and once a name is on it you generally can’t take it to a different practitioner.

However, there are some exceptions. “Say there are 2 doctors in the same practice and one has a particularly long wait time but the other’s is shorter,” says Dr McMullin. “Because they're at the same location, they're allowed to share that referral.”

If you have a specialist in mind, tell your GP before they write the referral. If you want to use a different specialist after the referral is written, you may be able to ask your GP to transfer it.

A standard referral is valid for 12 months from the date you first see the specialist (and not from when the referral was written).

“By sending the specialist an updated referral every 12 months, GPs are updating them on all the other things that are happening in that person's life and healthcare,” says Dr McMullin. “It creates an ongoing communication loop between the GP and the specialist.”

In some cases (like when a patient has a chronic condition), a GP can write an indefinite referral.

If a specialist refers you to another specialist, that referral is only valid for 3 months.

For Dr McMullin, when it comes to choosing a specific specialist to refer a patient to, there are no rules or guidelines. Her approach is a personal one.

“I like to ask my patient questions,” she says. “Do you have a preference? Have you seen a specialist before? Are you looking for public or private? Then I look at options near where they live or work.”

Dr McMullin adds that she’ll always choose a specialist who she knows and trusts. “I can tell you who’s competent and good under pressure. Who will bulk bill, and who won’t. Personalities come into play as well, not every patient will like the same person.”

GPs cannot receive any commission or kickback for specialist referrals. “The only payment they receive is for the normal cost of the consultation,” says Dr McMullin.

While specialist consultations vary in price, gone are the days where you’d be “surprised by the bill,” says Dr McMullin.

“Most of the time, when you book an appointment, they'll tell you the costs and your rebate.”

The Department of Health and Aged Care has a medical costs finder tool that can give you a general guide of medical costs in Australia, including specialist services.