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Dr. Mark Hosko, MD, January 6 2023

Can Urgent Care Refer You To A Specialist?

Learn More About Urgent Care Referrals

A specialist referral is a written request to a doctor who specializes in a specific medical condition. Your primary care provider is usually the one who writes it. However, an urgent care practitioner may issue a specialist referral for you after your visit if they feel it's necessary for your care. Referrals are a direct order sent to your insurance company to confirm that you require treatment beyond what your primary care provider can provide. Take a look below for more information. 

What is urgent care used for?

When your primary care physician's office is closed, urgent care centers give convenient access to high-quality treatment. Patients with urgent health needs receive the greatest care, usually without the waiting time found in an emergency room. As emergency rooms rank patients by the harm to life or limb, patients with minor problems need to wait longer for care. At urgent care, services are on a first-come, first-serve basis as the clinic does not handle life or limb emergencies. 

Urgent medical issues are ones that are not deemed emergencies but yet require care within 24 hours. These facilities can fill the gap between seeing a primary care doctor and emergency rooms, so all patients promptly get the care they need. You can see a provider at an urgent care center without making an appointment, just as you would at an emergency room. 

Furthermore, urgent care clinics frequently offer extended hours, 365 days a year (including most holidays), because they recognize that minor medical problems do not always occur during regular business hours. Another advantage of urgent care is checking in online and filling in all the paperwork from home for many clinics. 

What is treated at urgent care?

Urgent care clinics can cover a wide variety of issues that are non-emergent and do not pose a threat to life or limb. Some of the care available at urgent care include:

What is the purpose of referrals?

Most doctors study a specific portion of medicine, and anything outside their realm of specialty could cause a disservice to a patient who needs specialized care. Instead of trying to manage on their own, doctors will refer patients to a specialist to receive the best care possible. While patient referrals might be time-consuming and tiresome, they are a vital step in healthcare operations. 

Patients are referred to specialists when their main care practitioner feels that they need specialist care or when the patient's condition is too complex for the primary care provider to handle. However, while the process of issuing referrals appears to be basic, the requirements that would mandate the beginning of referrals are unclear at best. Making the wrong decision about a referral might result in major consequences for the provider.

The referral procedure is simple – if the first diagnosis decides that the patient needs extra care or medical advice, then the patient's doctor will identify providers or make an appointment with a specialist. In practice, the provider may merely advise a specialist because they know them, and checking for availability and securing an appointment with the specialist is easier said than done. Even if this requirement is met, the patient may wind up going to another expert or not get treated at all. 

Why are medical referrals important?

Many insurance companies require referrals to see a specialized doctor. Additionally, doctors are privy to the access necessary to choose the right doctor for their patients to ensure they get the necessary care for their condition. An organization's ability to effectively manage the health of a population is dependent on its ability to establish strong competencies across a wide range of areas and activities; however, no one clinic can provide every specialty patient's need. 

One of the most important success factors is the capacity to apply a single type of clinical decision accurately and efficiently across a large number of patients. Doctors will first exhaust all of their abilities and then find the right specialist before ensuring the patient why they need to see the new doctors. Doctors can make referrals for several reasons beyond struggling to make a diagnosis.

Physicians also refer when they want the opinion of a specialist. A specialist has greater knowledge and expertise in the domain of medicine in which they have chosen to concentrate.

Moreover, a specialist's opinion may differ from that of a general practitioner, which may benefit the patient. In some cases, a referral to a specialist may be necessary if the patient has risk factors or if the doctor simply wants a second opinion to confirm the appropriate course of action.

Patients may request a second opinion from a different physician. Most patients take an active role in their own care and are aware of their options. However, for some patients, more time or assistance is required. So, your doctors may seek a second opinion to corroborate their opinions or receive a better solution.

Every patient has a doctor with whom they disagree. You may not get along with certain doctors for various reasons, and the doctor may feel this too. As this is not in the patient's best interest, the doctor may refer you to a doctor whose views better align with your own. Finally, doctors may refer patients to a doctor who has a location closer to the patient, has more availability, speaks the same language as the patient, or is covered by the patient's insurance. 

Can I see a specialist without a referral?

You may be able to see a specialist without a referral, but it depends on your insurance and the doctor you are being referred to preferences. You will not be able to see a specialist unless you have received a reference from your primary care physician, according to several health insurance carriers. Your doctor will evaluate what kind of specialist you require and will recommend one or several that they believe you may benefit from seeing.

Before seeing a specialist, health maintenance organization (HMO) plans and point of service (POS) plans will require a recommendation from the primary care physician. Plan members who participate in preferred provider organization (PPO) or exclusive provider organization (EPO) plans, on the other hand, are not required to obtain a recommendation. By looking at your health insurance card, you may quickly determine your type of plan.

There are always exceptions to the norm, as they say. Specialists who provide mental health services, such as psychiatrists and psychologists, in your healthcare network do not necessarily require a recommendation from your primary care physician. 

Women also do not require a referral to see an obstetrician-gynecologist in the network for routine care, such as pap screenings and mammograms, if they choose to do so. Additionally, trips that the insurance company deems an emergency may not necessitate the use of a referral. You may need to travel to an urgent care facility or the emergency room to see a specialist right away if the situation is extreme.

What medical specialist treats stomach pain?

Gastroenterology is the branch of medicine that focuses on the digestive tract and the gallbladder, liver, bile ducts, and pancreas. Gastroenterologists are doctors who have received specialized training in diagnosing and treating disorders of the gastrointestinal (GI) tract and liver. Colonoscopies, which are procedures that examine the inside of your colon, are also performed by these experts regularly. Following medical school, they receive 5 to 6 years of specialized training.

What medical specialist treats migraines?

In medicine, neurology is the discipline of study and treatment of illnesses of the neurological system that is concerned with the study of these problems. In the human body, the nervous system is a complex and sophisticated system that governs and coordinates all of the actions of the body. Neologists focus on the brain, central nervous system, and peripheral nervous system, which can both be related to migraines. 

They receive three years of additional specialty training to become a neurologist. The majority of neurologists have further training or interest in a specific field of neurology, such as headache disorders, stroke, epilepsy, neuromuscular disorders, sleep medicine, chronic pain management, or movement disorders.

Why choose Portland Urgent Care for illness and injury treatment?

Portland Urgent Care treats numerous illnesses and injuries. Specialists can treat or refer patients to a specialist to give patients the care they need and deserve. We also work with numerous insurance companies and PIP to help more people. We can better serve you by combining western and eastern medical resources. Our chiropractors, physical therapists, acupuncturists, and massage therapists can help. We will also build a treatment plan for each patient based on their needs. Portland Urgent Care provides the tools to treat or refer patients to the right specialist for their care.

Conclusion

In the event of an acute or urgent medical sickness or condition, there are a variety of reasons why you may need to consult a specialist. The good news is that Portland Urgent Care can recommend you to a specialist during your appointment, allowing you to be seen for both short- and long-term care and rehabilitation. Understanding the referral process is critical in determining whether or not you may require a referral and how urgent care may assist you in obtaining one if you do require one. Call Portland Urgent Care today to get the medical attention you need.

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Written by

Dr. Mark Hosko, MD

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