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Are you a Medicare member? Visit rhodeahead.com/medicare.

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.

If your PCP believes you need to see a specialist, they can provide recommendations and a referral for one in your plan’s network. (Some plans require you to see your PCP for a referral, so be sure to check first.) If you belong to an Advance Primary CareSM practice, you know you’ll be referred to a specialist that offers high-quality, cost-effective care. For more information on Advance Primary Care, please see below.

Preparing for your specialist appointment

Before and while you’re seeing a specialist, your PCP and your 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 Woonsocket, 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

If you see a specialist recommended by your Advance Primary Care practice (see below), you may not need to ask all of the questions listed below. However, if you’re seeing a specialist you chose yourself, asking these questions is especially important.

  • 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.”

The advantages of Advance Primary Care

It can be challenging and time consuming to make sure that your PCP and specialist are communicating about your care. So why not choose a practice that takes care of that for you?

Blue Cross & Blue Shield of Rhode Island has partnered with Rhode Island’s top doctors to create Advance Primary Care (APC) practices. In an APC practice, your PCP leads a whole team dedicated to your care, which may include nurses, pharmacists, nutritionists, and more.

Here’s how an APC practice can help you when you need to see a specialist.

  • Recommend a specialist they know and trust.
    Many APC practices have certain specialists that they work with regularly and know provide high-quality, cost-effective care.
  • Make the appointment for you.
    This may help you get an appointment sooner, especially for busy specialist practices.
  • Send your medical information to the specialist.
    It’s important that your specialist has your medical history, test results, and other information before your appointment. (Many doctors can send this information electronically.) This helps you get the best care possible and avoids unnecessary tests.
  • Work with the specialist on a plan of care.
    Your APC team may be able to provide follow-up care to avoid repeated visits to the specialist. Nurse and pharmacist visits at your APC practice don’t cost you anything.

Don't have a PCP? To find an APC practice near you, please call Customer Service at (401) 459-1000. Visit bcbsri.com/howto to learn more about APCs.

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