A referral connects you with another clinician for a specific question, examination or treatment. Your primary care team should explain why the referral is being made and what information the specialist needs.
Referral and Authorization Are Different
A clinical referral is a recommendation for care. Prior authorization is a health plan's review process for certain services. Some plans require one or both, while others allow direct scheduling. Confirm the requirements before booking.
Questions to Ask
- Which specialty and clinician should I see?
- Is the provider in my plan's network?
- Has the referral been sent and is authorization required?
- Who will contact me about an appointment?
- Which test results, images or medication details should I bring?
- How will recommendations return to my primary care team?
If You Have Not Heard Back
Contact the referring office with the date of your visit and the specialty requested. Ask whether the request is awaiting information, insurer review or scheduling. Do not assume that silence means the referral has been approved.
If a request is denied, ask your health plan for the reason and the applicable review or appeal process.
If Symptoms Change
Let your care team know about a significant change while waiting. A routine referral timetable should not be used to decide how to respond to an emergency.