Need a Specialist?
If you have a skin problem, you might call a dermatologist. If you hurt your ankle, you might look for an orthopedist. However, your primary care physician (PCP) is your go-to resource and can help guide you to any other healthcare you need, including a specialist who treats certain illnesses or parts of the body. This helps make sure that all of your doctors are working together—and you’re receiving high-quality care that’s right for your medical history.
Start with your PCP
Your PCP should always be your first call for medical care that isn’t an emergency. “Primary care providers are trained to take care of common things uncommonly well,” explains Matthew Collins, M.D., M.B.A., vice president of clinical integration at BCBSRI. “They know you, your history, and your wishes for your health, and you should always seek their advice about your care and keep them informed about your medical needs.”
Your PCP may be able to treat your health problems rather than sending you to a specialist. That can save you time and money. This is especially true if you have a chronic but manageable condition such as diabetes or asthma. “You should reasonably expect to be able to get regular care for these types of conditions from your PCP,” Dr. Collins says. Learn more about how your PCP helps keep you healthy.
Why referrals are good for your health
If your PCP believes you need to see a specialist, they can provide recommendations and a referral for one in your plan’s network. For all individual BlueCHiP for Medicare plans, your PCP will coordinate referrals when you see a specialist, have a test, and receive some other services.
However, many important covered services still don’t require a referral, including behavioral health/substance abuse disorder services, emergency and urgent care, and retail health clinics such as CVS Pharmacy® MinuteClinic™.
Preparing for your specialist appointment
Before and while you’re seeing a specialist, your PCP and specialist should be communicating and sharing information about your care, including medical records, test results, and appointment notes. This helps all of your doctors coordinate their efforts to ensure you get the best care and experience.
While not a replacement for human communication, technology also plays a part. Electronic health record (EHR) systems are now widely used throughout the healthcare system to share information. Joseph Mazza, M.D., a cardiologist with the Cardiovascular Institute of New England in Cranston, says, “EHRs have become a much needed central repository for efficiently sharing critical information among all providers involved in a patient’s care.”
What to ask
When you’re seeing a specialist it’s important to ask these questions:
- Are you part of my BCBSRI health plan’s network?
- Do you have a lot of experience treating patients with conditions like mine?
- Which hospitals can you admit to? If you’re having surgery, ask about the hospital where your specialist wants to perform the operation.
- Do I really need surgery/tests or is there something else I can do to help the problem (for example, exercises at home)?
“I encourage patients to bring written questions to their appointment. I set aside time for them to ask their questions during a visit,” says Dr. Mazza. “Communication is a two-way street and one of the most important parts of the patient-doctor relationship.”
Common specialists used by BCBSRI members
- Cardiologist: Heart disease
- Dermatologist: Skin problems
- Gastroenterologist: Stomach problems
- Oncologist: Cancer
- Orthopedist: Bone and joint conditions
- Otolaryngologist: Ear, nose, and throat (ENT)
- Psychiatrist: Mental/emotional illnesses
- Pulmonologist: Lung issues
Have questions or need help?
You can call the Medicare Concierge Team with any questions you might have. Call (401) 277-2958 or 1-800-267-0439 (TTY: 711). Our hours are Monday through Friday, 8:00 a.m. to 8:00 p.m., Saturday and Sunday, from 8:00 a.m. to noon (open seven days a week, 8:00 a.m. to 8:00 p.m., from October 1 – February 14). You can use our automated answering system outside of these hours.